
Class 1^442^ 
Book 



GoBiight N?_ .Cfi_L^ii 



P 



COfVRIGHT DSPOam 



m 



SHORT TALKS 



ON 



Personal and Community 
Health 



BY 

LOUIS LEHRFELD, A.M., M.D. 

Agent for the Prevention op Disease, Department op Public 
Health, Philadelphia 



WITH INTRODUCTION BY 

WILMER KRUSEN, M.D., LL.D. 

director (1916-1919) Department of Public Health and 
Charities, Philadelphia 




PHILADELPHIA 

F. A. DAVIS COMPANY, Publishers 
1920 



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1^A 



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COPYRIGHT, 1920 

BY 



Copyright, Great Britain. All Rights Reserved 



PRESS OF 

F. A. DAVIS COMPANY 

PHILADELPHIA. U.S.A. 



©CIA597406 ^ 



INTRODUCTION 



Since 1908 the Department of Public Health 
and Charities has issued health bulletins in the 
form of short talks addressed to the public 
through the press on subjects of vital interest 
dealing with the prevention of disease and the 
promotion of the public health. It has been my 
experience that such education, while profitable, 
is rather slow. The quickest and most valuable 
way of teaching the public is through the schools 
and colleges. Public health education makes its 
greatest impression upon the young. Their 
minds can be molded to think along the lines of 
health and sanitation. 

The health talks in this book have received 
the hearty endorsement of the Department of 
Public Health and Charities of Philadelphia. 
They are written in such popular form as to be 
understood by every school pupil and college 
student. The subjects are so varied as to cover 
a very wide scope of public health work. A more 
intimate knowledge of these various principles of 
preventive medicine will be of greater material 
benefit than all legislation intended to regulate 
the habits and customs of the very busy Ameri- 
can public. 

WiLMER Krusen, M.D., 

Director, Department of Public Health and Charities, 
Philadelphia, 1916-1919. 

(Hi) 



PREFACE 



Public Health education is the foundation 
upon which rests the future progress of preven- 
tive medicine. The health officer cannot enforce 
his principles of sanitation and hygiene unless he 
can first make his community understand the im- 
portance of the various problems with which the 
public is confronted. The greatest drawback to- 
day in the programs of our health officials is ig- 
norance of the public in matters dealing with the 
prevention of disease and the promotion of pub- 
lic health. Many have tried through the press, 
by lecture, by health literature, to convince the 
public of the importance of rightful living. But 
the people whom we most desire to reach can 
neither read nor write, or their foreign customs 
are such that they cannot or will not accept the 
new American ideas. 

Our great housing problems, our infant wel- 
fare work, our effort to prevent occupational 
and infectious diseases, our campaigns to pre- 
vent accidents and our slogans to promote health 
depend entirely on the public's appreciation of 
the significance of these great factors. In order 
to bring our lesson home forcibly, we must 

(v) 



vi Preface 

educate and keep on educating the public. The 
manner in which this should be done so that it 
will include the rich and poor, the educated and 
the illiterate, is a problem. 

One way of solving the problem, as suggested 
by the Assistant Commissioner of Health of 
Pennsylvania, Dr. John D. McLean, is by edu- 
cating the children. They are the citizens of 
tomorrow. They are the books of information 
to illiterate parents. They are the foundation 
upon whom we rest the future progress of pre- 
ventive medicine. 

This book has been prepared primarily to 
accomplish the purpose just mentioned. It was 
designed to instruct the school pupil, the college 
student and the social worker in the elements of 
public health. The health talks are arranged in 
a short, concise manner, in popular form, free 
from technical terms, so as to be readily under- 
stood by the average person of school intelligence. 

Large industrial plants, appreciating the 
value of keeping their employes in good health, 
are adopting facilities such as rest rooms, re- 
creation fields and auditoriums for their benefit. 
The need for health education among these em- 
ployes is becoming more apparent each day. The 
subject matter in this book is so arranged and 
selected as to fit the need of such education. 



Preface vii 

Health lectures are being conducted in most 
of the large cities by the health authorities in 
the schools, in child welfare stations and among 
civic and social organizations. As a guide for 
such lectures, the subjects mentioned in this vol- 
ume should prove valuable. 

It is not aimed to teach the public how to 
treat disease, but rather how to prevent it and 
avoid it. 

Louis Lehrfeld, M.D. 



CONTENTS 



PART I 

Preventable Diseases and How to Avoid Them „^^^ 

PAGE 

Typhoid Fever 1 

Tuberculosis 5 

Fresh Air Treatment of Tuberculosis 7 

Facts about Tuberculosis, What is Tuberculosis 10 

Don't Catch the Grippe or Epidemic Influenza 22 

Sore Throat and its Significance 24 

Diphtheria Can be Cured 26 

Are You Immune to (protected against) Diphtheria ? 30 

Scarlet Fever ^ 34 

Household Care of Scarlet Fever 36 

Chicken Pox 39 

How to Avoid Smallpox 41 

Is Measles a Serious Disease ? 43 

Whooping Cough 45 

Mumps 47 

High Lights on Infantile Paralysis 49 

Cerebrospinal Meningitis 51 

Colds, Coughs, and Pneumonia 53 

Facts on Causes and Prevention of Pneumonia 55 

Why You Should Not Spit 57 

Hay Fever and Its Prevention 58 

Mouth Infections as the Cause of General Diseases 60 

Prevention of Insanity 62 

High Cost of Preventable Disease 66 

PART II 

Subjects for Spring and Summer 

Spring Tonics 68 

Malicious Medicine Habit 70 

Misbranded Medicine Condemned IZ 

(ix) 



Contents 



PAGE 

Getting Rid of Household Pests 75 

The Enemy at Home —The Fly 78 

Damage Caused by Rats 80 

The Bedbug as a Carrier of Disease 87 

Germs Useful in the Industries 90 

Disease Associated with the Soil 93 

Keeping Cool in Hot Weather 95 

First Aid to Heat Victims 97 

Safety Hints for Bathers and Boating Parties 99 

"Dog Days" 102 

Summer Resorts and Public Health 104 

Spoiled Meats and Ptomaine Poisoning 106 

PART HI 

Subjects for the Holidays 

Don'ts for the Fourth 110 

Health Hints for Christmas 112 

Health Resolutions for the New Year 115 

PART IV 

Miscellaneous Topics 

Health Day and Its Significance 117 

The Prevention of Physical Deformities 118 

Health of Women Wage Earners 121 

Recreation and Health 123 

What Exercise and Recreation Mean to School Children 124 

Exercise and Recreatio^i for the Busy Man or Woman 128 

Vacant Lots and Gardens 130 

Fresh Air — a Germicide 132 

The Open Window Habit 134 

Ventilate the Garage 137 

High Cost of Heating the Home 139 

Coal Gas Detrimental to Health 142 

Clean Streets Essential for a Clean Bill of Health 144 

Eliminating the Dust Nuisance 146 

Safety on the Streets 148 



Contents xi 



PAGE 

Occupation and Disease 151 

Prevention of Industrial Accidents 153 

Foot Strain and Its Relation to Health 155 

Underweight and Its Significance 157 

Cancer, a Curable Disease 159 

Sleep Essential to Good Health 162 

Proper Winter Clothing and its Health Aspects 165 

Stop That Noise 168 

Sanitary Barber Shops 170 

Sanitation of Swimming Pools 173 

Home Sanitation 175 

Disinfectants 178 

The Common Drinking Cup, Towel and Wash Rag 180 

Preventive Inoculation 182 

Clean Up Week— A Health Measure 185 

Disease Transmitted by Domestic Animals 187 

Regulating Rag Shops 191 

Sewage Disposal 193 

Refuse Disposal 195 

PART V 

Foods and Water 

Low Priced Foods with High Nutritive Value 196 

Handling of Food and Its Relation to Public Health 199 

Plea for Sanitary Restaurants 202 

Care of Milk in the Home 204 

What the Public Should Know About Milk 207 

Milk, A Perfect Food 210 

Pure Water 212 

Meat and Cattle Inspection 215 

PART VI 

Talks About Infants and Children 

Birth Registration an Important Subject 217 

Preventing Blindness Among Babies 219 

Care of the Baby During Hot Weather 221 



xii Contents 



PAGE 

Care of the Baby During Cold Weather 223 

Care of the Child During Pre-school Age 225 

Preparing the Children for School 227 

The Care of School Children 230 

Diet for the School Child 234 

Trivial Complaints Among Children 251 

Defective Vision Among School Children 253 

Conservation of Vision 255 

Good Teeth Essential to Good Health 258 

Tonsils and Adenoids 260 

Conservation of Hearing 262 

PART VH 
First Aid to the Injured 265 

Index 269 



PART I 

PREVENTABLE DISEASES AND HOW 
TO AVOID THEM 



Typhoid Fever 

T^YPHOID FEVER is an infectious disease 
caused by a germ called the typhoid bacillus, 
which enters the body through the digestive tract. 
This germ invades the whole body through the 
blood but does its principal damage in the intes- 
tines. The improper disposal of the body dis- 
charges of a typhoid patient may give rise to 
other cases. Either the nurse may become in- 
fected if she does not wash her hands carefully 
after handling the patient, or other persons may 
contract the disease from drinking unfiltered 
water, by eating shell food obtained from impure 
waters, salads which are washed with contam- 
inated water, milk which is not pasteurized or 
foods which are contaminated by handling or by 
flies. In country places where the outhouses are 
not properly screened, flies may convey the infec- 
tion to the food. 

(1) 



Typhoid Fever 



TYPHOID CARRIERS. 

Persons having had typhoid fever may after 
full recovery from the symptoms, continue to ex- 
crete from their bodies the germs of this disease. 
Such persons are called "carriers'' because they 
carry the germs in the body discharges. Their 
soiled hands coming in contact with food intended 
for others, spread the infection. There were 
many cases of typhoid fever in New York City 
which were traced to a servant who had the dis- 
ease and carried it to the families where she was 
employed. She is well known among public 
health officials as "Typhoid Mary." Carriers of 
this kind are quarantined by the health depart- 
ment until they are no longer dangerous to the 
public or they are not permitted to engage in oc- 
cupations which require the handling of food- 
stuffs. 

HOW TO AVOID TYPHOID FEVER. 

In the late summer and fall of each year there 
is an increase in the prevalence and mortality 
of typhoid fever. In Pennsylvania almost one- 
third of the cases are reported during the months 
of August and September. An analysis of the 
cases occurring during these months shows that 
25 per cent, of them were contracted by persons 
while on their vacation. This disease has, there- 



Typhoid Fever 



fore been properly termed "vacation typhoid," 
having been brought home by vacationists re- 
turning from country places, the seashore and 
mountains where proper sanitary measures had 
not been adopted to protect the public from in- 
fection. The water and milk supply are the chief 
sources of infection in summer resorts, while the 
less frequent sources of infection are foods con- 
taminated by flies and by handling, raw vege- 
tables washed in infected water or taken from 
fields fertilized with night soil, seafood taken 
from sewage polluted waters, and bathing in in- 
fected streams. 

The spring of the year is, therefore, the time 
to guard against avoidable infection with typhoid 
fever. One of the safest ways to secure almost 
certain immunity is by vaccination. This is at- 
tended with very little inconvenience, and com- 
prises the hypodermic injection of dead bacteria 
at three different sittings, lo days apart. The 
dangers of such inoculation are practically nil, 
for no ill effects have been experienced in the 
Army and Navy where everyone is required to 
be vaccinated. 

The value of inoculation has been proved be- 
yond all doubt. During the Spanish-American 
War there were over 2700 cases of typhoid 
fever, resulting in 248 deaths, among 11,000 



Typhoid Fever 



troops assembled at Jacksonville, Florida. Vac- 
cination was not advocated at that time. During 
the occupation of Vera Cruz, however, in 19 14, 
by the United States Expeditionary forces there 
was only one case of typhoid, and this occurred 
in a civilian who had not been vaccinated. In 
the same year there were only 6 cases in the 
whole army; two of these occurred in unvaccin- 
ated men, while the other four were already in- 
fected before receiving their inoculations. In 
the recent World War, typhoid vaccination gave 
final proof of its value. 

This preventive procedure should not be con- 
sidered as a substitute for the usual sanitary 
measures, such as good water supplies, clean 
milk, fly suppression, cleanliness and personal 
hygiene, but as an important adjunct to them. 
Persons who intend to travel during the sum- 
mer, especially in localities where typhoid may 
be prevalent, should protect themselves against 
infection by vaccination. While it has not been 
conclusively shown how long immunity from 
such inoculation lasts, it is claimed that at least 
three years can safely be relied upon. If the 
public should adopt this measure of protection, 
there will be less typhoid fever in this country 
and consequently a lower death rate. In 1919, 
many cities reported the lowest death rate from 



Tuberculosis 



this disease in their history. By ehminating the 
vacation cases, however, there would be estab- 
Hshed a very low typhoid rate. 

Get vaccinated now and avoid future trouble. 



Tuberculosis 

'T^HE widespread publicity which has been 
given to the campaign against the spread 
of tuberculosis has been greatly instrumental in 
reducing the incidence and the death rate of this 
disease throughout the country. 

Tuberculosis is always contracted from an 
existing focus, either from the infected sputum 
of man or from the infected milk of cattle. The 
latter source has been practically eliminated, as 
99 per cent, of the milk in the large cities is 
pasteurized. The fight against this disease, 
therefore, is limited chiefly to the proper dis- 
posal of the spittle of tuberculous patients. Warn- 
ing has been frequently sounded against the in- 
decent, foul and dangerous practice of spitting 
in public conveyances, railroad stations and on 
the open highways. This nuisance, nevertheless, 
still exists and tends to disseminate the disease 
to every individual who is susceptible. It is, 



Tuberculosis 



therefore, the duty of every person who has 
tuberculosis of the lungs, to deposit his sputum 
in a suitable cup or paper handkerchief which 
should be carried at all times and which can be 
readily destroyed after use. 

Progressive sanitary experts favor the es- 
tablishment of detention wards in our hospitals 
for the restraint of persons with advanced tuber- 
culosis who are dangerous to their fellowmen by 
reason of their physical condition or their care- 
less personal habits. Public opinion has not yet 
sanctioned such radical supervision but it is only 
a question of time when the healthy citizen will 
demand municipal protection from his infected 
neighbor. Detention of this character will re- 
quire a legal commitment backed by police sur- 
veillance. Such commitments must be either 
voluntary or by order of the court, and the 
method of procedure should follow the lines of 
commitment of insane patients. The eduQation 
of the public will accomplish this result in the 
near future. Meanwhile, it behooves all good 
citizens to urge the adoption of such a progres- 
sive sanitary standard. New York City has al- 
ready taken this step forward. 

Experience has shown that the chances for 
recovery from this disease are very great, pro- 
vided the condition is diagnosed in its beginning 



Fresh Air Treatment of Tuberculosis 7 

and treatment is carried on faithfully and per- 
sistently. Fresh air, sunshine, good food and 
regular habits are the natural and best remedies 
and these are within reach of the rich and poor 
alike. On the other hand, poor housing, poor 
food and other limitations of poverty accentuated 
by the use of alcohol are important factors which 
obstruct the progress of this campaign against 
tuberculosis. 

Of particular interest is the fact that tuber- 
culosis among colored people is on the increase 
while among whites it is steadily decreasing. 
This indicates the need of more persistent ef- 
forts to inform the poor and uneducated about 
matters of public health. Instruction in the pub- 
lic schools should aid materially in accomplishing 
this purpose. 



The Fresh Air Treatment of 
Tuberculosis 

TN the past there has been a general exodus 
of tuberculosis patients to the Western States 
in the attempt to secure climatic living con- 
ditions which may effect a permanent cure, 
or at least arrest the further progress of the 



8 Fresh Air Treatment of Tuberculosis 

disease. This popular idea has brought many a 
hardship upon famihes of meager means who 
have spent their fortunes in the hope that dear 
ones afflicted with this disease might obtain the 
benefit of travel and favorable climate. Places 
known for their dry atmosphere, and located at a 
relatively high altitude were Meccas of refuge. 
Very often those who were on their way to re- 
covery were overtaxed by the burden of travel, 
change of scene from home, and the mental de- 
pression resulting from the absence of friends 
and relatives, and, instead of improving, their 
condition became worse. 

Of late, there has been a gradual but decided 
change in the trend of opinion regarding the 
travel of tuberculous individuals to places distant 
from home where climatic conditions are said to 
be ideal. Many of our infected population can- 
not afford to make such expensive trips which 
often prove of no avail. The medical profession 
has been inclined toward recommending places 
near home, but just far enough away to insure 
atmosphere free from the dust and dirt of the 
city in overcrowded and overheated living quar- 
ters where infection breeds and spreads, and also 
just near enough so that the patient may, at fre- 
quent intervals, be in contact with those near and 
dear to him. 



Fresh Air Treatment of Tuberculosis 9 

There are a number of places in the suburbs 
of every large city and state close to home where 
tubercular patients may receive the fresh air cure. 

In fact the outdoor life in that part of the 
country where the temperature varies, has a 
stimulating effect upon the body, promotes more 
active resisting powers, and does not have the 
disadvantages which accompany an unaccus- 
tomed climate at a distance from home. The 
beneficial effects of high altitude have probably 
been overestimated. The advantage of the fresh 
air in localities to which the patient has already 
become acclimated overbalances those in places 
of low atmospheric pressure. A low pressure 
causes extra work upon the heart muscles of the 
patient already physically depressed by reason of 
his chronic disease. 

The number of persons who are permanently 
cured of tuberculosis is increasing rapidly each 
year. This is proved by the actual number of 
discharges from sanatoriums and by the findings 
at autopsies which show healed lesions in the 
lungs of persons who have died from other 
causes. Furthermore, during the last thirty-five 
years the death rate from tuberculosis has been 
reduced one-half as a direct result of education 
of the public on methods of prevention and on 
the simple measures of treatment. A still greater 



10 What is Tuberculosis F 

reduction in the mortality from this disease and 
an increase in the number of cures can be secured 
by the adoption of open air treatment in the 
vicinity of the patient's home. 



Facts About Tuberculosis. What 
is Tuberculosis? 

T^UBERCULOSIS is a disease of the lungs, 
or, less commonly, of the bones and glands 
caused by a germ called the tubercle bacillus. 
This germ produces and throws off poisons 
which kill the structures around it. This germ 
grows and produces more germs, invading the 
whole body until finally it kills the person in 
whom it grows. In recent years it has been 
shown that the germ frequently gets into the body 
in childhood, but, since it does not grow easily 
in the human body, many of these germs are 
killed at once by juices in the body. Others are 
inactive for a long time in the glands of the chest 
or abdomen and do not develop until by some 
chance the resisting power of the body is lowered 

Note : Many extracts in this section are from "What You 
Should Know About Tuberculosis," by the National Association 
for the Study and Prevention of Tuberculosis. 



What is Tuberculosis F 11 

sufficiently for the germ to grow, the thoroughly 
healthy body not being a favorable growing 
place. Overwork, dissipation, dark dirty homes 
or work-places, bad or scanty food, late hours, 
drunkenness, and certain diseases, such as grippe, 
measles, whooping cough, pneumonia and typhoid 
fever weaken the body, give the germ the oppor- 
tunity it needs and enable it to develop. In 
bodies thus weakened, the germ can flourish, 
and, if they are not strengthened in time by 
proper living, the disease will progress. This 
advance is usually slow and gradual, so that 
the patient may live from two to ten years, 
but in the more rare form its advance is rapid, 
so that the patient dies in from six weeks to a 
year. 

NATURAL RESISTING POWERS. 

Fortunately for us the germ of tuberculosis 
does not grow easily in the human body. All 
animals have a certain degree of resistance to 
the germ. In some this resisting power is 
very low; in some very high. The guinea pig, 
for example, has almost no resistance to this dis- 
ease, while the goat has so high a resistance that 
it is very hard to infect it at all. Among human 
beings the Indian and probably the Negro show a 
very low resisting power, and when infected, are 



12 What is Tuberculosis F 

apt to have the rapid and dangerous form of the 
trouble. The average white man on the con- 
trary has considerable resisting power, and it 
takes repeated, prolonged exposure and un- 
favorable conditions of working and living, to 
infect him, except in early childhood, when, it 
should never be forgotten, infection is very easy. 

HOW THE GERM DEVELOPS. 

The first manifestation of the activity of the 
germ in the body is the formation, usually in the 
lungs, of a small gray lump, which we call a 
tubercle. This is about the size of the head of a 
pin, and when examined under a microscope, it is 
seen to consist of a cheesy mass of dead tissue 
with germs lying in it. The formation of this 
dead tissue by the poisons of the germ is called 
''Caseation." Surrounding the cheesy center is a 
double layer of cells thrown out by the body to 
protect itself from the invading germ. If the 
poisons of the germ are sufficiently strong, or if 
the cells surrounding the germ are sufficiently 
weak, they too will be destroyed, and by degrees 
successive layers of tissue will be killed, the 
trouble thus spreading at the outer border 
through larger and larger areas of tissue until 
finally the whole lung is involved. When the 
mass of dead tissue reaches an air tube it is 



What is Tuberculosis f 13 

coughed up and leaves a small cavity behind. 
When this cavity becomes bigger, other sorts 
of germs from the outside air may get into it and 
help the tubercle germ to spread destruction, 
thus finally producing what we call "Consump- 
tion." 

If, however, the body is put under favorable 
conditions of feeding, of fresh air and of wise 
living, its cells will be so strengthened that it 
will be able to kill the poison of the germs. 

The disease can be compared to a battle be- 
tween the germs which have gotten into the body 
and the cells which make it up. If these cells 
are well nourished and cared for they will win, 
and will shut in and finally kill the germ; if not, 
the germs will, by degrees, kill them and cause 
the patient's death. 

TUBERCULOSIS MAY BE CURED. 

Once the disease has attacked the body, it 
always leaves scars behind, as a careful exam- 
ination of dead bodies will show. Since, how- 
ever, with careful living, these scars will remain 
firm and strong, enclosing the trouble, in which 
by degrees the germ may die out, patients may 
justifiably be considered "cured"; but it must 
never be forgotten that as a result of dissipation, 
poor housing conditions, neglect of personal 



14 What is Tuberculosis f 

hygiene and cleanliness, overwork or sickness, 
the disease may break out again. 

Tuberculosis is not like typhoid fever or 
smallpox, or measles, or scarlet fever, which dis- 
eases are easily and quickly taken if you come in 
contact with those who have them, and which 
develop in from one to two weeks. It is caught 
much less easily, takes a long time to develop 
after it is caught, and can be prevented from 
developing very often by clean living, or can be 
cured or arrested in a large number of cases if it 
has not gone too far. Therefore, it is not neces- 
sary to despair and give up hope if you, or some 
one you love, has caught this disease, but it does 
demand an immediate improvement of your ways 
of life and of your surroundings, so as to 
strengthen your body to the utmost in order that 
it may be able to shut in, wall up and conquer 
the trouble. In tuberculosis, scars are always left 
and germs for a long time may be found in these 
scars, and improper living can enable them to 
break out again, but, as ample experience has 
shown, it may be so successfully walled in that 
all symptoms of its presence will be lost, and the 
patient can resume a normal and useful life if 
only he is willing to live wisely and prudently. 
However, a relapse is always possible after an 
arrest, even after many years. 



What is Tuberculosis F 15 



INFECTION FREQUENTLY TAKES PLACE IN 
CHILDHOOD. 

Infection very frequently takes place in early 
childhood through the alimentary tract. The 
germs enter the lymphatic glands and lie quiet 
here for many years. It seems probable that 
many of those who develop the disease in adult 
life have carried the hidden infection since child- 
hood and have not received a new infection when 
symptoms of the disease appear. 

A BAD AIR DISEASE. 

As has been said, this disease is probably 
caught in most cases in childhood and lies in- 
active in the body for a longer or shorter time 
until the conditions are favorable for it to de- 
velop, but it can be acquired at any time or age. 
Since the germ can, and often does, lie quiet in 
the bod}^ for many years before it develops and 
is discovered, it is usually difficult or impossible 
to say just when or under what circumstances 
the person became infected. It should always be 
remembered that it is almost always a house or 
indoor infection, and that it is rarely if ever 
caught outdoors where the sunlight, which is our 
best disinfectant, quickly kills the germ. Thus 
the great and real danger is from living with 



16 What is Tuberculosis F 

careless, dirty consumptives, and especially in 
dark, damp, dirty or ill-ventilated houses, sleep- 
ing and living rooms, workshops, factories or 
stores, which have become infected with the germ 
by the sick people's careless spitting habits. The 
germ, which is a microscopic rod, invisible to 
the unaided human eye, is found in millions in 
their spit from very early in the disease, and it is 
through this spit almost alone that it reaches 
others. If we could collect and destroy all the 
spit of such patients and make them cover their 
mouths when they cough, we could almost wipe 
out the disease. Fortunately, when people spit 
outdoors the danger is not quite so great, since, 
sooner or later, the sunlight will destroy the 
germ; but when they spit indoors, as many do, 
where the sun cannot get at the germ and kill it, 
it may remain alive and active for a long time. 
Hence people who spit in this way are a ter- 
rible danger to all who live with them, or to those 
who stay in the places where they live or work. 
Many people do not know that they have tuber- 
culosis, but think that they have only a ''bad 
cough," when they already have the disease and 
are bringing up the germs in their spit. Every 
one, therefore, who spits or has a cough should 
be just as careful about his spitting as if he knew 
that he had tuberculosis. If those with germs in 



What is Tuberculosis f 17 

their sputum spit on floors or sidewalks, the 
sputum will be ground under foot, blown around 
as dust in the air, and inhaled by other people, 
and will finally reach the lungs. 

INFECTION FROM CARELESS PERSONS IN THE 
HOME. 

In the home the chief danger, as has been 
said, is to children, although adults may also be- 
come infected. The two chief sources of infec- 
tion for children are, first, consumptive relatives 
or fellow lodgers, and secondly, infected rooms, 
dwellings or dishes. Children are apt to be kissed 
and fondled, and in this way the germs may be 
carried directly to them. Again, they play 
around on the floors, too often infected with spit, 
and thus acquire the trouble. Therefore, the 
kissing or fondling of little children by sick rela- 
tives or friends should be prohibited, as well as 
the bad habit of feeding them from the spoons 
and plates of such people. Indeed, as far as pos- 
sible, children should be kept away from their 
sick relatives as long as the latter cough and spit. 

THE DANGER OF INFECTED ROOMS. 

No one should move into a previously oc- 
cupied home until all the rooms are thoroughly 
cleaned and aired. In the dark corridors of many 



18 What is Tuberculosis f 

houses the germ may Hve for a long time and un- 
fortunately many people who would not spit on 
the floor of a bedroom, will do so on the floor of 
a corridor. If every one should see to it that his 
home is kept strictly clean, that as much sunlight 
as possible is admitted to it, and that no one is 
allowed to spit on the floor, it would do much to 
lessen his family's danger of catching this dis- 
ease. 

Dry sweeping of rooms should never be 
allowed, as it raises clouds of dust, which may 
contain the germs, which are thus breathed di- 
rectly into the lungs. Therefore, all broom 
sweeping should be preceded by strewing the 
floor with damp sawdust, old tea leaves or bits of 
wet paper and if it is at all possible, vacuum 
sweeping or cleaning should be used. 

HOW WORKING MEN INFECT ONE ANOTHER. 

Outside of the home, there is much danger in 
insanitary shops, workshops, factories and mills. 
Experience shows that both clerks and w^orkmen 
too often spit carelessly on the floors of their 
w^ork places, and since some of them, often with- 
out knowing it, have the disease, they infect their 
fellow workmen. Every year thousands of 
American laborers are made sick in this way. 



What is Tuberculosis? 19 

INFECTION FROM A COUGHING PATIENT. 
"droplet INFECTION." 

Infection is also carried by coughing and 
sneezing by which acts fine sprays of mucus are 
thrown into the air carrying with the droplets, 
the germs of tuberculosis. This could be entirely 
avoided, if every one formed a habit of covering 
his mouth with a handkerchief at such times. 
This danger is so real that public opinion should 
enforce such a custom. 

INFECTION THROUGH MILK. 

The germ may also be taken into the body in 
uncooked cow's milk. Cows frequently have 
tuberculosis and the germ may get into the milk, 
sometimes in large numbers. While in grown 
people this is not a common source of infection, 
it is a frequent source in little children who drink 
much uncooked or unpasteurized cow's milk. 
The germs are carried by the milk into the 
bowels, pass through their walls and enter 
the system through the lymphatics, lodging usu- 
ally in the glands around the roots of the lung, 
or in those attached to the intestines. Therefore, 
unless one is certain that the cow which supplies 
the milk is free from tuberculosis (which can be 
told by a test that a good veterinary doctor can 



20 What is Tuberculosis f 

easily make), the only safe thing is to pasteurize 
or boil all milk which is used by the children of 
the household. 

HEREDITARY INFECTION. 

It is now known that tuberculosis is not hered- 
itary, and that it is practically never handed on 
from the parents to the child before birth. We 
recognize, on the contrary, that the infection 
comes from tuberculous parents or relatives, who 
usually infect the healthy born child a short 
time after birth, if their habits are careless. 
Even with much care it is difficult to avoid the 
infection of the children by their tuberculous 
parents. When we see a whole family die of 
this disease, one after another, it does not mean 
that they inherited it from the parents, but that 
there was carelessness in the family and that 
each child in turn acquired the disease from the 
careless parent, brother or sister. However, in 
families in which there has been much tubercu- 
losis among the parents or grandparents, there 
is at times found a lowered resistance to the dis- 
ease so that the children in such families must 
be brought up with especial care as to their sur- 
roundings and life. 



What is Tuberculosis f 21 



THE DUTY OF THE PATIENT TO THE 
COMMUNITY. 

If all people who have any spit would destroy 
if carefully, would cover their mouths when they 
cough, would refrain from kissing and would 
keep their hands clean, and if all milk, for chil- 
dren at least, were boiled or pasteurized before 
use, unless it came from cows tested for tuber- 
culosis, it would not be long before we would get 
rid of the trouble entirely. 

HOW TO DISINFECT THE HOME. 

Hang up by two corners in each room a sheet 
thoroughly wet with a quart of 40 per cent, for- 
maldehyde solution, after first shutting up all the 
doors, windows and fireplaces, and stopping up 
all the cracks with strips of newspaper put on 
with starch paste. Keep the room shut for 
twenty-four hours, and then keep all windows 
wide open for two days. There are several bet- 
ter but more expensive methods of disinfection 
with formaldehyde, which you can learn of from 
the Board of Health or your doctor. 

Thorough scrubbing of floors and woodwork 
with hot water and soap is an essential part of 
disinfection, followed by exposure to fresh air 
and sunlight. Remember, that mere fumigation 



22 Don't Catch the Grippe 

with formaldehyde, without vigorous appHcation 
of soap and water, and the letting in of sunlight 
and air, will not kill the germs of tuberculosis. 



Don't Catch the Grippe or Epidemic 
Influenza 

Tr\ON'T fail to avoid intimate contact with 
persons having colds or coughs. If re- 
quired to work in the same office or shop with 
persons known to have the grippe, insist on 
proper ventilation of the room. 

Don't mingle unnecessarily in large crowds. 
Places of amusement and public conveyances owe 
it to their patrons to afford them reasonable 
safety and protection from avoidable infection 
by maintaining proper and effective ventilation. 

Don't forget that careless spitting on the 
sidewalk and in public places adds to the sources 
of general distribution of the disease. 

Don't fail to use your handkerchief when 
coughing or sneezing as the fine spray of mucus 
resulting therefrom contains the infectious 
agents which may be inhaled by others. 

Don't forget that fresh air and sunlight are 
the best germicides. It is, therefore, desirable 



Don't Catch the Grippe 23 

for indoor workers to seek the open whenever 
possible. The windows of the bedroom should 
be so adjusted as to permit a constant supply of 
fresh air. The night air is by no means harmful 
as some folks will have us believe. In fact it is 
purer than the day air which is contaminated by 
dust, odors and vapors from the various manu- 
facturing establishments. 

Don't neglect the ordinary ''cold in the 
head" for it may lead to more serious conditions. 
See your family physician and place yourself un- 
der his observation. 

Don't rely on home remedies or patent medi- 
cines. You are unable to diagnose your own ail- 
ments and less capable of prescribing for them. 
Let your doctor do it. 

Don't fail to dress according to the tempera- 
ture of the day. During inclement weather ade- 
quate protection should be provided against a 
cold and damp atmosphere. 

Don't forget that children and the aged are 
very susceptible to the influences of cold weather. 
Respiratory diseases are frequently fatal when 
contracted by them. 

Don't permit your resistance to drop below 
par by fatigue and excesses. 

Don't forget the frequently repeated warn- 
ings against the use of common towels and drink- 



24 Sore Throat and Its Significance 

ing cups, and against kissing, especially during 
an epidemic of grippe. 



Sore Throat and Its Significance 

A COMMON affection during the winter 
months, which is too often considered with 
indifference, is sore throat. It is not generally 
known however that inflammation of the throat 
is only a local manifestation of a more serious 
and systemic condition and should be regarded 
with suspicion more especially among children. 
Diphtheria and scarlet fever are the serious in- 
fections which make their early showing by evi- 
dences of changes in the normal condition of the 
throat. Parents should, therefore, be mindful of 
this fact and seek the advice of the family physi- 
cian immediately to determine the nature of the 
disease. 

Records of Health Departments show that 
most cases of diphtheria are often treated at home 
for several days before a physician is consulted 
or before the disease is reported to the Division 
of Medical Inspection. It is during this period 
of illness when no special isolation of the patient 
is adopted and when friends and visitors go to 



Sore Throat and Its Significance 25 

and from the infected household, that the infec- 
tion is carried to other famihes and the disease 
permitted to spread. This can largely be ob- 
viated if all cases of sore throat among children 
be considered with suspicion and the patient kept 
isolated from other members of the household 
until the correct diagnosis is made. Reports fre- 
quently show secondary cases of diphtheria oc- 
curring in the same house which were due to 
failure on the part of parents or guardians to 
isolate the original case at the very onset of sore 
throat. While a large percentage of cases of 
scarlet fever are reported from the first to the 
third day of the disease, yet it is this period 
without isolation which is a serious source of 
contagion to others. 

The lesson to be learned, therefore, is to set- 
tle all matters of doubt regarding early sore 
throats by consulting the family physician who 
understands the importance of an early diagnosis, 
not only from the standpoint of isolation to avoid 
secondary cases but also from the standpoint of 
treatment, this being especially true in cases of 
diphtheria when the best results are obtained 
from the use of antitoxin at the very onset of the 
infection. 

Other inflammatory conditions of the throat 
such as the various forms of tonsilitis and 



26 Diphtheria Can be Cured 

pharyngitis should not be regarded lightly be- 
cause they are invariably infectious in nature and 
may lead to more serious consequences. Acute 
rheumatic conditions, valvular disease of the 
heart and general blood poisoning may have their 
origin from infected tonsils. In this respect, 
adults as well as children may suffer serious 
physical injury by neglect of nature's warning — 
sore throat. 



Diphtheria Can Be Cured 

T^IPHTHERIA is a curable disease and to a 
great extent preventable. It is one of the 
few diseases for which we have a positive and 
specific curative agent known as antitoxin which 
through years of experience has become recog- 
nized as the only remedy capable of preventing 
death in the case of diphtheria. 

Prior to the introduction of diphtheria anti- 
toxin more than one-half of the cases of diph- 
theria died. Today, however, only one out of 
every eight cases of diphtheria proves fatal. 
Health officials believe that even this death rate 
can be largely reduced by the early and proper 
use of diphtheria antitoxin. In fact it has been 
definitely proved that every case of diphtheria 



Diphtheria Can be Cured 27 

can be cured if the antitoxin is given during the 
first twenty-four hours of the disease. Such has 
been the experience at the Philadelphia Hospital 
for Contagious Diseases where thousands of 
cases have been treated with the remarkable 
record that no case has ever been lost when the 
antitoxin was administered during the first 
twenty-four hours of the disease. 

In order that this specific remedy may be ad- 
ministered early in every case, it is necessary for 
the parents or guardians of children to call in 
the family physician whenever suspicion of the 
disease may arise. 

HOW TO RECOGNIZE EARLY CASES OF 
DIPHTHERIA. 

Whenever the child has a sore throat with 
white flaky deposits on the tonsils, immediate 
suspicion of this dangerous disease should be en- 
tertained. It is not necessary to wait for further 
symptoms, such as fever or marked physical de- 
pression, to appear before calling in the family 
doctor, since diphtheria is ofttimes very rapid in 
its course and may prove fatal if the proper 
treatment is not administered at once. 

Croupy cough is another suspicious symptom 
of diphtheria. When this disease affects the 
larynx or voice box, hoarseness of the voice and 



28 Diphtheria Can he Cured 

the characteristic ringing cough are the prom- 
inent symptoms. If the antitoxin is not admin- 
istered immediately the patient may die from 
strangulation by obstruction of the windpipe 
caused by the diphtheritic membrane. When 
diphtheria affects the voice box it produces a very 
distressing and pitiable condition. If the public 
could only see some of these children fighting for 
air there would be no question that every precau- 
tionary measure would be taken to prevent diph- 
theria. Furthermore, this particular type of in- 
fection may last for many months and even years. 
Prolonged convalescence is caused by delay 
in giving the diphtheria antitoxin. Artificial 
means of respiration must often be made in these 
cases by the introduction of a tube into the wind- 
pipe in order that the patient may breathe. In 
some instances these tubes must remain for long 
periods of time, oftentimes years, in order to 
sustain life. 

A running nose is also a characteristic pre- 
monitory sign of diphtheria. Parents should 
look for a dirty-white material which obstructs 
the breathing. Diphtheria first appearing in the 
nose is ofttimes overlooked; for this reason we 
make special mention of instances where chil- 
dren suffer from cold in the head and obstruction 
in breathing. 



Diphtheria Can be Cured 29 

Every case of diphtheria begins in one of the 
ways mentioned above. In order to be on the 
safe side every case of tonsiHtis and sore throat, 
hoarseness of the voice, croupy cough or running 
nose should be treated by the family physician. 
The use of home remedies is dangerous because 
it delays time in making the proper diagnosis and 
in giving the early administration of diphtheria 
antitoxin. 

ADVANTAGES OF HOSPITAL TREATMENT. 

Attention is also called to the fact that cases 
of diphtheria treated in a hospital for contagious 
diseases have a better chance for recovery and 
of more rapid convalescence than those treated 
at home, for the reason that expert doctors and 
nurses especially trained in the treatment of con- 
tagious diseases are in attendance at the hospital. 
Furthermore, isolation is better maintained at the 
institution than at the home where secondary 
cases may arise among other children or adults 
who are in the family. 

Parents should never hesitate to send their 
children to a hospital for contagious diseases 
when the family physician believes that they can- 
not be adequately taken care of at home. 

It is only by mutual co-operation of the par- 
ents, the family physician, and the health authori- 



30 Are You Immune to Diphtheria? 

ties that the mortahty rate of diphtheria can be 
held in abeyance. More especially do we place 
emphasis on the administration of diphtheria an- 
titoxin in the first twenty-four hours of the dis- 
ease by which procedure we hope to cure every 
case of diphtheria. 



Are You Immune to (Protected 
Against) Diphtheria? 

A COMPETENT physician can determine 
whether you can or you cannot catch diph- 
theria by a simple method known as the Shick 
test. 

What is the Shick Test? 

A dose of diphtheria toxin is injected between 
the layers of the skin of the arm. If the person's 
blood contains antitoxin, nothing happens and 
the patient is declared immune. If, however, 
a distinct circumscribed area of redness appears 
at the site of the injection the test is declared 
positive, which means that the person does not 
have in his blood sufficient resistance against 
diphtheria and is liable to contract the disease. 
By sufficient resistance is meant certain chemical 
substances called antibodies. 



I 



Are You Immune to Diphtheria? 31 

What is meant by Diphtheria Toxin f 

This is the poison produced by the diphtheria 
germs and is obtained by growing the bacteria in 
broth for a certain length of time after which 
they are killed by carbolic acid. 

What is meant by Diphtheria Antitoxin f 

This is a serum produced by inoculating the 
horse with diphtheria toxin. The animal's resist- 
ing power causes the antitoxin to be produced in 
the blood. 

Is there any risk to the test? 

Absolutely none. When the test is positive, 
the redness which appears, gradually disappears 
on the third or fourth day. 

What is the idea of having the test made? 

Diphtheria is a very serious disease. About 
one out of every eight cases is fatal. The in- 
fection exists in this country throughout the year 
and children between the ages of two and ten are 
most susceptible. Every father and mother 
wants to know if their children are liable to catch 
this disease and if so how it can be avoided. 

The Shick test determines this. There is a 
serum called toxin-antitoxin which when injected 
confers immunity to those who react positive to 
the Shick test. 



32 Are You Immune to Diphtheria? 

When should the test he made? 

All children over the age of one year should 
have this test made. Nursing infants seem to 
have a natural immunity to the disease, because 
of protective substances in mother's milk. 

What is a negative test? 

If no redness of the skin develops after the 
Shick test, it mean^^ that the blood contains suffi- 
cient resisting power to diphtheria. Persons 
having a negative test and exposed to diphtheria 
do not develop the disease. 

Are adults immune to diphtheria? 

After the age of ten, the occurrence of diph- 
theria gradually lessens. Few adults contract 
this infection, and are relatively immune to the 
disease. Statistics show for ' ^ cent, positive 
Shick test for children, and \ per cent, posi- 
tive for adults. 

Is there no intermediate reaction between posi- 
tive and negative? 
Yes. The reaction may be strongly positive, 
positive, moderately positive and faintly posi- 
tive, depending upon the degree of the redness 
of the skin. 



Are You Immune to Diphtheria f 33 

// the test is positive what is done to prevent 
diphtheria? 
A serum which is a combination of toxin and 
antitoxin is administered under the skin at three 
sittings, seven days apart. 

Does the toxin-antitoxin semm cause any harm? 
No. Local and constitutional symptoms are 
noted in twenty to fifty per cent, of cases. These 
are redness, slight swelling ^nd tenderness of the 
arm and a slight rise of temperature. The symp- 
toms, if any, disappear within forty-eight hours. 

How long does this acquired immunity last after 
the toxin-antitoxin administration? 
In 95 per cent, of cases previously suscep- 
tible, the protection against diphtheria lasts for 
years, possibly for life. To make sure of the 
duration of immunity the Shick test can be made 
regularly evc ^ir. 



What is the pra^Hcal value of the Shick test? 

In every school, institution, hospital or home 
where large numbers of children are quartered, 
diphtheria may break out at any time. By test- 
ing every child on admission, one can determine 
which children are susceptible to the disease. 
Those who react positive are given the toxin- 
antitoxin treatment. In this way diphtheria may 



34 Scarlet Fever 



be eradicated. If diphtheria breaks out in your 
home, antitoxin is given to those who react posi- 
tive to the Shick test. In this way persons im- 
mune to the disease avoid the inconvenience of 
having the serum injected. 



Scarlet Fever 

CCARLET FEVER is usually regarded as a 
very serious disease, but, as a matter of 
fact, it causes about one-third as many deaths as 
measles. This comparison is made not to lessen 
or lighten in any way the dangers encountered by 
this infection, but to point out how a very con- 
tagious and fatal disease may be made non- 
virulent by careful, judicious and systematic 
control. 

About 95 per cent, of the cases occur under 
the. age of 21 and by far the largest propor- 
tion of these occur among children of school age. 
It is the early diagnosis and isolation that have 
greatly reduced the number of scarlet fever cases 
in the last few years. 

Another factor which requires emphasis is 
that the isolation should be absolute. By this we 
mean that no one other than the nurse and doctor 



Scarlet Fever 35 



should be admitted in the sick room; nor should 
the nurse come in contact with other household 
duties. When scarlet fever is treated at home, 
the likelihood of spreading the infection to other 
members of the household, especially to children, 
is great. The safest and wisest precaution in 
such instances is to have the patient removed to a 
hospital for contagious diseases, where, under 
expert care, the child is assured a more speedy 
recovery and the danger of complications is 
lessened. 

Sore throat is an early conspicuous symptom 
of scarlet fever. When a child has been well and 
playful and suddenly becomes very ill with such 
symptoms as high fever, vomiting, sore throat 
and reddened tongue, parents should immediately 
entertain a suspicion of this disease. When a red 
rash shows itself about the face and body, the 
evidence is strong in favor of scarlet fever. 
Delay in securing medical attention at once 
favors the dissemination of the infection among 
others, prolongs the duration of the disease and 
increases the likelihood of complications which 
are often more serious than the disease itself. 
Early treatment and early isolation are, there- 
fore, the by-words in this as in all other contag- 
ious diseases. 



Household Care of Scarlet Fever 

CCARLET FEVER, even in its lightest forms, 
is one of the most dangerous of the con- 
tagious diseases. It is contagious from its very 
beginning until shedding of the skin is completed 
and discharges from the nose, ears and throat 
have disappeared. A person gets scarlet fever by- 
taking in the germs that have been shed from a 
case of the disease, either in the process of des- 
quamation or from the discharges, usually by 
the breath, but sometimes even by having these 
germs come in contact with a raw or cut surface. 
They remain alive in rooms or clothing which 
have not been disinfected, certainly for months, 
and possibly for years. 

It is best for both the patient and the com-, 
munity that scarlet fever cases be treated in hos- 
pitals. 

When the patient is treated at home, the fol- 
lowing precautions are necessary for the protec- 
tion of those who have not had the disease : — 

The patient should be removed to the room 
which can best be shut off from the rest of the 
house. This room should be stripped of carpets, 
curtains, hangings, and all but the absolutely 
necessary furniture; the windows should be fly- 
screened during the summer. 
(36) 



Household Care of Scarlet Fever 37 

As the germs of the disease settle everywhere 
in the form of a fine dust, the nurse should wipe 
off all surfaces in the room and the door-knob, 
daily, with a moistened cloth. 

The hair of the nurse should be completely 
protected by a covering of washable material and 
the outer garment by a long gown or slip. These 
coverings and her shoes must be left in the sick 
room when she leaves it. Outside the sick-room 
she should wash her hands, and then her face and 
neck thoroughly with soap and water. 

Dishes, and other articles used by the patient 
and nurse, should be placed in a bucket con- 
taining boiling water, kept at the sick-room door, 
before being taken to the kitchen for scald- 
ing. Food left over should be burned. 

Towels, napkins, clothing and bedding should 
not be shaken and aired and washed until after 
being disinfected by boiling. Vessels in which 
bowel movements or urine are carried from the 
room should be wrapped in a towel. 

No one should enter the sick-room but the 
doctor and the nurse. 

No teacher or scholar living in the house 
at the time of the outbreak of scarlet fever, or 
during the course of the disease, can attend 
school until authorized to do so by the health 
authorities. 



SS Household Care of Scarlet Fever 

Milk jars cannot be returned to the dealer 
until they have been disinfected under the super- 
vision of the health officials. 

The house should be disinfected when the at- 
tending physician may desire it, but the final 
fumigation and removal of the placard should 
not take place until the case is completely through 
the peeling or shedding stage, and all discharges 
from nose, ears, throat and glands have ceased. 
This may not be completed for several weeks. 
The danger of contagion during this period may 
be lessened by daily greasing the entire body with 
cold cream or vaseline. 

When the house is ready for disinfection, 
everything that has been used about the patient, 
the clothing worn by the nurse, and the over- 
clothing worn by the doctor should be left in the 
sick-room, where it will be freely exposed for the 
proper time to the action of the disinfectant. 

Scarlet fever patients are dangerous to others 
for some time after they are strong enough to 
leave the bed. As long as there is the least shed- 
ding of the skin or discharge from the nose, ears, 
throat or glands, the patient should be kept away 
as much as possible from well persons. When 
the doctor says the patient may go out he should 
not mingle with well persons any more than is 
absolutely necessary for the first week or ten 



Chicken-pox 39 



days. Great care should be taken to prevent the 
patient from taking cold. If there is persistent 
running from the ears, they should be lightly 
plugged with cotton, and these plugs burned as 
soon as the}^ are removed. 

It is plain that a case of scarlet fever, if 
properly managed, causes much trouble to those 
in the house, and in many private families it is 
not possible to care for these cases in a proper 
way. Such cases are much better off in a hos- 
pital equipped for treating this disease, where 
they are treated by physicians who are experts 
in the disease; they are attended by nurses who 
are trained to manage the disease properly; as 
they recover they have the advantage of special 
sunparlors, and open grounds in which to play 
and get air without danger to themselves or 
others. 



Chicken-pox 

/^HICKEN-POX is an infectious disease 
affecting children, although adults may 
sometimes become infected. It occurs as a rash 
upon the skin with many watery blisters, at- 
tended by fever. Fatal cases are invariably as- 
sociated with complications, chief of which is 



40 Chicken-pox 



pneumonia. This latter disease takes an unusual 
toll among young children and every effort 
should be taken by parents of children affected 
by the childhood diseases to avoid any such com- 
plication. 

Chicken-pox is an important disease from a 
public health standpoint because it may be mis- 
taken for mild cases of smallpox in which event 
it may lead to a serious epidemic if not recog- 
nized and isolated immediately. Parents are, 
therefore, urged to have these cases attended to 
immediately by the family physician with the 
view of obtaining a correct diagnosis. 

In every case, isolation of the patient is es- 
sential. Other children in the household should 
not be permitted to enter the sick-room, nor 
should neighboring children be permitted to visit 
the sick. It is not essential for every child to 
have the chicken-pox to ''have it over with" as is 
erroneously believed by many. Such belief has 
been shelved with other obsolete and unscientific 
medical fables. 

The placing of a placard on the front door of 
the home for this disease does not prevent the 
free entrance and exit of the adult occupants of 
the house. It is merely a warning sign to others 
that the disease exists in the household and that 
those who enter may transmit it to others, 



How to Avoid Smallpox 41 

The hearty co-operation of the pubHc is 
asked in obe3ang the quarantine regulations re- 
garding chicken-pox, which are the only effec- 
tive means the health officials have in limiting 
the spread of this disease. 



How to Avoid Smallpox 

T^HOSE who are familiar with the history of 
smallpox will remember that this pestilence 
is one of the most dreaded diseases throughout 
the world. It is, therefore, not surprising that 
the health authorities use all effort to wipe out 
the source of infection from every community. 
Wholesale vaccination is recognized as the only 
known and positive method to prevent the spread 
of this disease. All persons who desire to pro- 
tect themselves and their families should act ac- 
cordingly, by submitting to this important pre- 
ventive measure. Revaccination will do no harm 
and will reassure protection against smallpox. 

The value of vaccination has been proved be- 
yond all doubt and those who refuse to submit 
to it endanger the safety not only of their house- 
hold, but of the community at large. Like all 
other marvelous achievements of science, the use 



42 How to Avoid Smallpox 

of vaccine virus has been most unjustly criti- 
cized. At the present time it does not seem 
plausible that anyone would reject it in view of 
the fact that the medical profession of the whole 
world has advocated it. 

There can be no greater assurance of the 
protective power of vaccination than the fact 
that doctors and nurses mingle freely with small- 
pox patients and do not contract the disease be- 
cause they are vaccinated. The possibility of 
tetanus following vaccination has been greatly 
exaggerated and the chances of this complication 
are nil if the operation is performed under asep- 
tic precautions and the wound protected from 
subsequent infection. 

Practically all complicated cases give a his- 
tory of carelessness in handling the site of in- 
oculation. The virus used is absolutely free from 
tetanus germs or their poison. This has been 
proved by an examination of virus sufficient to 
vaccinate two million persons by the United 
States Public Health Service. Such a guarantee 
by the Federal authorities leaves no room for ob- 
jection to the use of vaccine virus. 

The Pennsylvania State Vaccination Com- 
mission made a thorough investigation of the 
value of vaccination. A summary of its report 
made in 1913 is as follows: 



Is Measles a Serious Disease f 43 

That the protective power of vaccination 
against smallpox has been conclusively estab- 
lished. 

That vaccination is a relatively harmless pro- 
cedure. 

That there is no available substitute for vac- 
cination in the prevention and supp;-ession of 
smallpox epidemics. 

That this report affirming the efficacy of vac- 
cination is in harmony with the reports of all of 
the official governmental commissions that have 
considered this subject. 



Is Measles a Serious Disease? 

IV/rORE children die from measles than scarlet 
fever. This fact is not generally known 
but as soon as the public realizes that measles 
is not to be considered lightly and with indif- 
ference so soon will the deaths from this infec- 
tion be reduced to a minimum. 

In order to stay the spread of this infection, 
it is essential that every case be isolated im- 
mediately and that the family physician report 
the same to the health authorities at once. Moth- 
ers requesting their family physician not to re- 



44 Is Measles a Serious Disease f 

port measles to the health officials are placing the 
doctor in a very embarrassing situation. Under 
the State law, a physician may be prosecuted 
who wilfully fails to report such cases. There 
appears to be no logical reason why objection 
should exist against placing a placard on the 
door of the house which indicates to neighbors 
and to friends that measles exists in the house- 
hold. Adults may leave and enter the house 
without molestation and there is little or no in- 
convenience caused by the posting of this sign. 

Every unreported case of measles is a serious 
menace to others and acts as a distributing focus 
of the infection to neighboring children. When- 
ever a death occurs from this disease, it is a pre- 
ventable one and indicates that some person or 
persons have contributed negligence either un- 
knowingly or without realization of the serious- 
ness of the disease. 

It is admitted that measles is very difficult 
to control because of the prevailing public opin- 
ion of the infection and because science has not 
as yet brought forth any specific preventive or 
curative measures for the disease. It is un- 
known how many deaths occur among children 
whose parents thought it prudent to expose them 
to the infection "to have it over with.'' This 
principle of exposure has long been exploded and 



Whooping Cough 45 



relegated among the ancient obsolete methods of 
medical science. At least the disease may be 
avoided until the child is older and when he is 
more physically able to resist the possibilities of 
complications which are inva;riably the contri- 
buting causes of death. 



Whooping Cough 

/n|NE of the most distressing diseases of child- 
hood that reaches the height of its preval- 
ence in the Spring is whooping cough. Parents 
should therefore adopt the principle of prepared- 
ness by protecting their little ones from infection 
with this exhausting and dreaded disease which 
caused nearly twice as many deaths as scarlet 
fever. 

Whooping cough is not to be considered 
lightly or with indifference. Aside from its high 
mortality rate, the pain and suffering caused by 
this disease should arouse every mother's anx- 
iety to keep this infection away from her house- 
hold. To do this effectively, instruct the chil- 
dren not to play with others who have the dis- 
ease. If your child has the infection, it is your 
duty not to allow other healthy children to be 
in its company. All discharges from the mouth 



46 Whooping Cough 

and nose ©f the sick child should be received in 
paper napkins or clean cloths which should then 
be burned, since it is through these secretions 
that the disease is spread. Separate cups, 
glasses, plates and other eating utensils should 
be kept for the sick child. 

Those who are familiar with the symptoms 
of this disease will remember that the child first 
complains of an ordinary cold in the head. There 
is slight fever, dry cough and running of the 
nose, and the eyes appear bloodshot. The cough 
becomes worse and more persistent especially at 
night and is soon followed by a succession of 
violent coughs causing a flushing of the face and 
a sense of suffocation. There is a common and 
by no means inaccurate expression that "the 
child coughs until it is black and blue in the 
face." This paroxysm of coughing may last sev- 
eral minutes and is followed by a sharp loud 
crowing sound or whoop which gives the dis- 
ease its descriptive name. The child is often 
quite exhausted after these spells which may, in 
some instances, cause rupture of the bloodvessels 
of the brain, hemorrhage in the eye and nose 
bleed. 

No one can actually appreciate the suffering 
of these little^ children affected with this disease 
until he has seen a patient in one of the spasms 



Mumps 47 



of coughing. Every effort should therefore be 
made to reduce the severity of these attacks or 
the frequency of their occurrence by avoiding all 
forms of excitement. Laughing, crying, over- 
eating and drinking may provoke these cough- 
ing spells. During the febrile period, the child 
should be kept in bed in a well ventilated room. 
The bedclothes and clothing of the child should 
be disinfected by boiling. 

If the child is well enough to be up and about, 
it may be taken out in the open, either in the 
back yard or on the enclosed porch, but by no 
means should other healthy children be present. 
All cases of whooping cough are restricted from 
school until the disease is cured, nor are they 
allowed to visit public places or to ride in public 
conveyances. Obedience to the precautions men- 
tioned will greatly assist in reducing not only the 
incidence of whooping cough, but also the high 
infant mortality of every community. 



Mumps 



'\X7HAT is looked upon as one of the milder 

diseases of childhood and early youth, and 

w^hich probably does not receive its full share 

of watchfulness and care, is the disease known as 



48 Mumps 



"Mumps.'' This is a germ disease, the period of 
development varying from ten to twenty-one 
days after exposure to contagion, the disease 
spreading from one person to another through 
contact with those suffering from the disease. 

It is most hkely to occur between the ages of 
five and fifteen, but is very infrequent in early 
infancy. The disease is more prevalent in the 
spring and fall months. 

It first shows itself by pain and stiffness be- 
hind the lower jaw and under the ear, followed 
by a broad swelling of the cheek, most notice- 
able under and in front of the lobe of the ear, 
usually appearing on the left side first, and fre- 
quently followed in a few days by pain and swell- 
ing on the other side. The pain is increased by 
movement of the jaws, as in the drinking of 
liquids or in the chewing and swallowing of food. 

The following conditions complicating mumps 
are not to be overlooked: 

High fever causing delirium. 

Delirium caused by certain brain conditions. 

Deafness which may be lasting. 

Children should not be neglected during an 
attack of mumps, as the disease may seriously 
affect certain important organs of the body. 



High Lights on Infantile Paralysis 

npHIS disease is so called because it affects 
chiefly infants and young children, and is 
characterized by paralysis of one or more parts 
of the body. 

Younger children are more susceptible than 
older children. Adults, however, may sometimes 
contract the disease. 

It is caused by a poisonous substance, called 
a virus, which is capable of passing through the 
finest filter, and when inoculated into a monkey 
causes symptoms similar to infantile paralysis. 

This virus has been detected in the secretions 
of the nose, throat, and intestines of persons af- 
fected with the disease. 

Coughing, sneezing, kissing and spitting may 
distribute the disease to others, as may also the 
ingestion of foods contaminated by infected 
persons. 

A most important disseminator of the dis- 
ease is the "carrier" who harbors the infectious 
agent in his secretions, but is not affected or 
made sick by its presence. 

Flies and other household insects are said to 
transmit the disease. 

Street dust may also disseminate the dried 
virus of this infection. 

4 (49) 



50 High Lights on Infantile Paralysis 



The average case begins with fever, pain in 
the head, back and hmbs, stiffness of the extremi- 
ties, and in infants symptoms resembhng sum- 
mer diarrhea may be evident. Within twenty- 
four or seventy-two hours signs of paralysis be- 
gin to appear, usually in the lower, often in the 
upper extremities. Pain and tenderness exist 
along the nerves and in the muscles, on pres- 
sure. After the acute symptoms subside the 
stiffness of the limbs gives way to weakness and 
flaccidity, which are soon followed by wasting of 
the muscles. The resulting paralysis, however, 
may be much improved by constant and proper 
medical treatment, and in some instances cured. 

PREVENTIVE DON'tS DURING AN EPIDEMIC. 

Don't allow the children to play with others 
who are strange or unknown. 

Don't take the children to places where the 
disease is known to exist in epidemic form. 

Don't fail to observe the general rules of 
sanitation which apply to all other infectious 
diseases. Screen the doors and windows and 
destroy all household insects. Keep the gar- 
bage pail tightly covered, and see that its con- 
tents are taken away on the regular collecting 
days. Personal cleanliness is especially essential 
to ward off this disease. 



Cerebrospinal Meningitis 51 

Don't forget that fresh air, sunshine and 
good food are excellent preventive remedies, for 
these increase the individual resistance, and les- 
sen the susceptibility to infectious diseases. 
Children should, therefore, not be confined to 
their homes, but allowed a reasonable amount of 
freedom for play. 

Don't fail to call your doctor at the first sign 
of illness of your child. To prevent the spread 
of this disease it is necessary that most care- 
ful attention shall be given to all cases of sus- 
picious illness and unremitting attention main- 
tained in carrying out the requirements for keep- 
ing children in good health. 

Don't be deceived by patent medicine cures. 
There is at present no specific remedy for in- 
fantile paralysis. 



Cerebrospinal Meningitis 



4C 



CPINAL MENINGITIS" as it is commonly 
called is an acute infectious and communi- 
cable disease caused by a germ which gains en- 
trance to the central nervous system through the 
nose and throat. The attention of the health 
officials and the public is called to this disease 



'i'^ Cerebrospinal Meningitis 

because of its unusual prevalence in the larger 
cities. 

The seasonal prevalence of this disease fol- 
lows closely that of pneumonia. The most im- 
portant factor responsible for the spread of this 
disease is the "carrier." This is a person in ap- 
parently good health who harbors the germs of 
the disease in the nose and throat, transmitting 
the infectious germs to others who are suscep- 
tible to the disease and who may readily contract 
it. When the infection is prevalent, a large num- 
ber of these carriers may be found. In order to 
check the disease, therefore, it is necessary that 
every case of suspected cerebrospinal fever be 
isolated and that all persons in contact with each 
case be examined and kept under watch of the 
health officer. 

Cerebrospinal meningitis is a very fatal dis- 
ease. Fifty-five per cent, of the cases die. 
Among those who recover, permanent or at least 
prolonged disability may result. Children and 
young adults are especially susceptible. The dis- 
ease attacks the nervous system and is attended 
with high fever, headache, backache, extreme 
prostration, and later convulsive seizures. It 
may terminate fatally within a very short time. 

There is, however, a curative remedy for the 
disease,. This is a serum which when injected 



Colds, Coughs, and Pneumonia 53 

early into the spinal canal of the patient com- 
bats the infecting organisms and their poisons, 
bringing about an early convalescence. The pre- 
ventive measures for this disease are exactly 
those of pneumonia. Coughing, sneezing and 
expectoration are the spreading agents of infec- 
tion and should be controlled by the well accepted 
methods advocated from time to time in the 
health bulletins. Good food, fresh air and warm 
clothing are favorable protectors against this 
disease. 



Colds, Coughs, and Pneumonia 

'PVERY person who has a cold in the head 
or a cough should be careful to protect 
others by seeing to it that all nasal and mouth 
secretions discharged by the act of coughing and 
sneezing should be deposited in proper recep- 
tacles or in pieces of cloth or paper which can 
readily be destroyed by burning. The people 
should protect themselves by avoiding spitting in 
public places and attention is called to the law 
which prohibits expectoration on the sidewalks, 
in public buildings, and public places as well as 
in conveyances. It is highly probable that colds 
and pneumonia owe their spread largely to this 
dangerous habit. 



54 Colds, Coughs, and Pneumonia 

A person affected with a cold should sleep in 
a room by himself, and if that is impossible, 
should sleep in a separate bed. Any one who 
feels creepy or chilly or hot should take his tem- 
perature and if it is above the normal mark on 
the thermometer, should go to bed and send for 
a physician. 

These simple concise suggestions may be fur- 
ther supplemented by the advice to avoid places 
where there is overcrowding, especially if the 
ventilation is poor or improperly maintained. 

Proper and sufficient clothing should be worn 
according to the daily weather and not accord- 
ing to the season of the year. The skin is an 
accessory organ to the lungs, and its function 
should not be impeded by scant or improperly 
selected clothing. 

Bed clothing has been claimed to be an active 
medium of transmitting infectious colds, partic- 
ularly in lodging houses and hotels which are 
not conducted in the strictest sanitary manner. 
Airing of bed linen and blankets is, therefore, 
advisable at various intervals. 

Too often the ordinary cold in the head is 
neglected, or the patient expects time to act as 
the healer. While it is true that many cases of 
"cold'' resolve themselves without treatment, 
there are many instances in which it is the fore- 



Causes and Prevention of Pneumonia 55 

runner of a more serious affection of the respira- 
tory tract. Early treatment is therefore sug- 
gested to avoid the possibility of complications. 
Home remedies are too often relied upon and thus 
delay the proper and effective treatment by the 
experienced physician. The usual prevalence of 
coughs and colds has already begun and should 
act as the forewarning of more serious infec- 
tions of the lungs. Consult your family doctor 
about the cough, hackipg, or cold in the head 
that seems to ''hang on" after the usual house- 
hold remedies have failed. 



Facts on the Causes and Prevention 
of Pneumonia 

PNEUMONIA is an acute infectious and com- 
municable disease and at present causes 
more deaths than pulmonary tuberculosis. It is 
a disease of the lungs which comes on suddenly, 
or is a complication of other diseases. 

Twenty-five per cent, of the fatalities occur 
among infants before their first birthday. 

The first year of life and the age period of 
50 to 70 years contributes one-half of the deaths 
from pneumonia. During the influenza epidemic 
of 19 1 8, adults between the ages of 20 and 40 
were chiefly affected by pneumonia. 



56 Causes and Prevention of Pneumonia 

The least number of deaths occur between 
the ages of lo and 15 years. 

The rich and poor aHke are affected by this 
disease. 

Infection occurs in large gatherings, in pub- 
lic places and in homes where proper ventilation 
and heating are not properly carried out. 

Epidemics of pneumonia are always as- 
sociated with an increased number of deaths 
from heart disease, pulmonary tuberculosis and 
Bright's disease. 

Exposure to extremes of cold and inclement 
weather predisposes to infection. 

Improper and insufficient clothing, which 
permit the chilling of the body, reduces the re- 
sistance to pneumonia. 

To guard against this disease, one must be 
adequately protected by warm clothing. Public 
conveyances and public places should be ade- 
quately ventilated. Fresh air is a germicide and 
kills the germs of pneumonia. Such air must not 
necessarily be cold and freezing temperature. 
Warmed fresh air is much more comfortable and 
desirable indoors than the raw wintry atmos- 
phere. 

Spitting in public places is a dangerous and 
unlawful practice. Pneumonia may be commu- 
nicated through such a foul and repugnant habit. 



Why You Should Not Spit 57 



Infants and the aged should be guarded 
against exposure to cold by adequate heating and 
ventilating in the home, as they are very sus- 
ceptible to the influence of extreme cold weather. 

Persons should keep in good ''trim'' to in- 
crease the resistance against the disease by avoid- 
ing excesses of all kinds, by obtaining eight hours 
sleep each night, by avoiding fatigue caused by 
long hours of work, and by avoiding persons who 
cough and sneeze. 

Persons suffering from colds, no matter how 
trivial, should seek the advice of the family 
physician, since pneumonia may be preceded by 
inflammation of the upper respiratory tract. 



Why You Should Not Spit 

tJECAUSE spittle may contain the germs of 
disease. 
Because promiscuous spitting may spread 
tuberculosis, tonsillitis, 

pneumonia, sore throat, 

influenza, infectious colds, 

diphtheria, bronchitis. 

Because two out of every one hundred per- 
sons are affected with tuberculosis, who may 
spread the disease by careless spitting. 



58 Hay Fever and its Prevention 

Because one out of every four deaths is 
caused by tuberculosis and pneumonia. 

Because persons in apparently good health 
may harbor the germs of disease in the secre- 
tions of the nose and throat without themselves 
falling ill. 

Because spittle may be carried home by shoes 
and skirts. 

Because spittle contaminates the atmosphere 
which we must all breathe. 

Because the health of every man, woman and 
child is jeopardized. Because it is unlawful. 



Hay Fever and its Prevention 

TF you should chance to hear a passerby sneeze 
repeatedly, remember that the hay fever 
season is on. This periodic affection, occurring 
about the tim.e of the hay harvest is a widely dis- 
tributed disease, affecting both children and 
adults and causing much distress and misery 
among its many victims. 

Beginning like an ordinary cold attended with 
blocked nasal passages and characterized by 
paroxysms of sneezing, the disease may at first 
attract little attention, especially among children, 



Hay Fever and its Prevention 59 

when it is often mistaken for the usual cold. Un- 
like the latter condition, however, the nasal dis- 
charges usually remain thin and watery and be- 
come thickened only toward the termination of 
the disease. Cough is a common symptom while 
asthmatic attacks may often occur. These symp- 
toms are very depressing to patients who often 
become very low-spirited. 

The disease was first described in the early 
part of the 19th Century when it was termed 
autumn catarrh, since it occurred chiefly in the 
late summer and early fall. There is a type of 
the disease which is also prevalent in the spring, 
while in the Southern States the affection occurs 
all the year round. 

The disease is caused by the action of pollen 
of certain plants which is carried by the winds 
and finds lodgment in the nostrils of persons who 
are particularly sensitive to this affection. The 
most important plant which is the chief offender 
in this locality is the common rag weed. This 
weed which grows to the height of one to five 
feet and blooms from August to October or later 
can be found on almost every vacant lot, neg- 
lected field, on the roadsides, and in uncultivated 
gardens and lawns. Its pollen is abundant and 
is readily distributed by the wind. From a public 



60 Mouth Infections 



health standpoint, therefore, such noxious weeds 
are a nuisance and a menace. 

The best method of eradicating hay fever 
weeds is the cuhivation of neglected grounds, but 
where this is not feasible, the dangerous weeds 
should be uprooted or cut down before the flower- 
ing stage. This prevents the formation of pollen 
and the production of the seeds. United action 
on the part of the public to rid their community 
of noxious weeds will greatly assist in eliminating 
hay fever which is an entirely preventable disease. 



Mouth Infections as the Cause of 
General Diseases 

/^ NE of the most recent advances in medicine 
is the discovery that many of the general 
systemic and organic diseases arise from infec- 
tions of the mouth. The most frequent of these 
sources is the teeth, while next in importance are 
the tonsils and sinuses or cavities in the bones of 
the face. To the average laymen it may seem 
unbelievable that heart diseases, rheumatism, 
chronic joint inflammations, muscular pains, in- 
digestion, stomach and intestinal disorders in 
many instances are caused by hidden or unsus- 



Mouth Infections 



61 



pected abscesses at the roots of teeth, mibedded 
in the tonsils or concealed in the bony cells of 
the face which have direct communications with 
the nose and mouth. 

We may go still further. General systemic 
diseases with vague or indefinite symptoms, 
melancholia, neurasthenia and neuritis may be 
caused directly by the infectious or toxic products 
of abscesses about the teeth or tonsils. A peculiar 
feature about these infections is that no symp- 
toms may be caused at the original seat of the 
abscess and for this reason the patient's attention 
and ofttimes that of the doctor is not drawn to 
the true and original focus of disease. It is said 
that the haphazard and careless filling of teeth, 
imperfectly adjusted crowns and bridgework may 
be the cause of concealed and poisonous teeth 
abscesses which infect the blood stream and lodge 
in such places as the joints, muscles, heart and 
kidneys. 

Numerous instances can be cited by medical 
practitioners where the source of unexplained 
systemic diseases arise from infections in the 
mouth. X-Ray records are many which point to 
abscesses about the teeth which could not have 
been diagnosed in any other way. 

This emphasizes the importance of cleanliness 
of the teeth and mouth. Routine measures of 



62 Prevention of Insanity 

brushing the teeth and rinsing the mouth with a 
suitable lotion prescribed by the dentist or doctor 
will be a material aid in avoiding the formation of 
such abnormalities. It also indicates the necessity 
of having the tonsils removed after successive 
attacks of tonsilitis. 

The medical profession has learned the im- 
portance of clean, sound teeth as a preventive 
measure against serious constitutional diseases. 
It remains for the public to take advantage of 
this well recognized principle of hygiene by prac- 
ticing routine cleansing of the mouth and by 
applying to the dentist for the correction of any 
defects which may encourage the formation of 
abscesses. 



Prevention of Insanity 

TV/TILLIONS of dollars are spent each year for 
the care of the insane. While this large 
expenditure is for a good cause, it can and 
should be much reduced since medical science has 
proved that about one-third of all cases of in- 
sanity are preventable. Some authorities make 
still greater claims, stating that 40 to 50 per cent, 
of insanities can be prevented. 



Prevention of Insanity 63 

One of the most common causes of insanity 
which can in a large measure be controlled is 
alcoholism. It is a well recognized fact that alco- 
hol, when used to excess by persons of feeble 
mentality, is responsible for about lo per cent, 
of all cases of insanity. Venereal disease, which 
seems to go hand in hand with alcoholism, con- 
tributes about 13 per cent, of cases. Thus it is 
shown that these two preventable causes contri- 
bute a large proportion of cases to the insane 
population of a city. 

Immigration is another fruitful source of 
cases which can and should be largely eliminated. 
This importation of insane, coupled with the bur- 
den of their care, has become a serious and 
troublesome problem for the local and national 
health authorities. The test of literacy is want- 
ing in weeding out imbeciles and degenerates 
who may be able to read and write well, while 
the healthy illiterate may become a valuable citi- 
zen and the parent of children of high potential 
intelligence. 

The negro contributes a goodly share to the 
census of the insane. He lacks a guiding hand, 
thus making him dependent upon his own re- 
sources. Useful trades and arts are denied him 
and as a result he leads a life which predisposes 
him to alcoholism and social disease. 



64 Prevention of Insanity 

Heredity can be traced in nearly 50 per cent, 
of all cases of insanity. This may explain the 
Biblical phrase regarding the sins of the fathers 
being visited upon the children unto the third 
and fourth generations. The intermarriage of 
feeble-minded persons is a fertile source of many 
imbeciles and idiots. Segregation and institu- 
tional care should, therefore, be insisted upon in 
order to prevent a degenerate progeny. 

Among other causes of insanity are acute in- 
fectious diseases, certain poisons taken internally 
or produced in the body, injuries to the head, and 
heat exhaustion. 

Laborers and the unemployed furnish a large 
proportion of cases, thus showing that those of 
feeble mentality cannot progress far in their pur- 
suits. This brings up the question of controlling- 
such persons as tramps, vagabonds and the in- 
efficient who cannot or will not work. 

Attention is also called to the popular writ- 
ings referring to operations on the brain for the 
correction of moral delinquencies. This is an 
erroneous conception, since surgery cannot cure 
many of these cases. 

The following measures should be adopted to 
prevent the great loss of useful citizens caused 
by insanity: 



Prevention of Insanity 65 

( 1 ) Education of the public as to the dangers 
of alcohol and venereal disease. 

(2) The adoption of strict measures on im- 
migration to prevent the importation of the in- 
sane and more stringent laws of deportation of 
the insane alien. 

(3) Teaching the negro useful occupations. 

(4) Protection of the unemployed. 

(5) Institutional care of the insane to pre- 
vent propagation of a degenerate offspring. 

(6) Careful medical supervision of children 
with neurotic tendencies and with a hereditary 
history of insanity. 

(7) Persons showing the slightest signs of 
mental disturbance should seek the advice of a 
physician at once. Early treatment may mean a 
permanent cure. 

(8) Stated hours of relaxation and diver- 
sion secures good mental health, 



The High Cost of Preventable 
Disease 

T^ ACH year thousands of cases of communi- 
cable diseases are reported to the Health 
Departments. The number reported, however, is 
only about one-third of the actual cases of in- 
fectious diseases which occur, there being a large 
number of the minor reportable diseases which 
do not come to the attention of the physician. 
If, to this estimated prevalence of sickness caused 
by preventable diseases, were added the cases of 
illness arising from various hazardous employ- 
ments, from faulty housing conditions, from 
neglect or lack of intelligent care, the extent of 
disease from purely avoidable causes would reach 
enormous proportions. Moreover, if such sick- 
ness were valued in dollars and cents, the calcula- 
tion would approximate large sums of money. 

It has been estimated that the economic sav- 
ing throughout the country, if needless sickness, 
deaths and fatigue could be prevented, would be 
about 1,500 millions of dollars annually. 

Although it is not known just what propor- 
tion of diseases and deaths are avoidable, it is a 
recognized fact that the percentage is by no 
means a small number, especially if we include 
the diseases among infants and children. 
(66) 



High Cost of Preventable Disease 67 

This economic problem has not only attracted 
the attention of health officials, but is now be- 
ing earnestly discussed by civic organizations 
throughout the country. A united effort is being 
made to divide the burden of sickness among 
those more or less responsible for the conditions 
predisposing to disease and premature death. 
This divison of the cost of disease has been 
molded in the form of health insurance, which 
aims to protect the low wage earner from finan- 
cial reverses in the event of sickness in his fam- 
ily by making provision for medical attendance, 
for medical supplies, and financial assistance. 



PART II 

SUBJECTS FOR SPRING AND 
SUMMER 



Spring Tonics 

TT is estimated that $75,000,000 are spent an- 
nually in the United States for patent medi- 
cines, a large number of which are the so-called 
spring tonics. The actual value and benefit of 
such medications may be exemplified by the fol- 
lowing remark made by a prominent druggist 
who conscientiously opposed the sale of cure-alls. 
A customer applying at the drug counter asked 
the pharmacist what a certain patent medicine 
was worth. The scrupulous clerk replied, "worth 
absolutely nothing, but if you ask what it sells 
for that is entirely different." 

It appears strange that at this age of general 
enlightenment when public health education is be- 
ing spread broadcast, that millions of people will 
still believe that health can be found in the medi- 
cine bottle. We fully appreciate that many of our 
home remedies are efficient and may relieve many 
(68) 



spring Tonics 69 



complaints when properly administered. It is an 
error, however, to place faith in the patent medi- 
cine which claims to cure or relieve any and all 
complaints or each and every disease. 

In the Spring, when the active mental and 
physical energy is somewhat slackened, and when 
the indoor worker, fatigued during the trying- 
winter months, is anxious for a lull in the usual 
routine, there is a general wave of tiredness and 
exhaustion which seems to overtake the average 
wage earner. This is called in common parlance 
''spring fever." In order to combat this feeling 
of inactivity, persons will often resort to the use 
of the so-called spring tonics. 

It is this indiscriminate use of medicine that 
takes millions of dollars needlessly and waste- 
fully from the public purse. Furthermore, the 
usual patient is incapable of diagnosing his own 
case, and even less able to select from the many 
bottles on the drug store shelves which may suit 
his individual case. The taking of patent medi- 
cines gives the patient a false sense of security, 
and during the period of medication, the actual 
physical disorder or disease may be progressing. 

In the vast majority of instances the so-called 
''spring fever'' requires nothing more than the 
usual home remedies. Discretion in diet, atten- 
tion to the personal physical needs, routine out- 



70 The IVlalicious Medicine Habit 

door exercise, and an occasional mild laxative 
will go a long way toward eliminating that tired 
and seemingly exhausted state which occurs at 
the onset of mild, fair and warm weather. Should 
these general hygienic measures fail, then your 
case is one which requires the attention and skill 
of a medical practitioner. 



The Malicious Medicine Habit 

A LTHOUGH the dope fiend is under the con- 
stant vigilance of the police and Federal 
authorities, the habitual medicine user goes un- 
restricted, purchasing drugs by the bottleful and 
pills by the hundreds. The latter evil is by no 
means a trivial one, as many a poor person has 
been made poorer, the sick sicker and the weak 
weaker, because of the mistaken belief that health 
could be found in the medicine bottle. Tradition, 
custom and the ''medicine man" have been largely 
responsible for the extensive use of many of the 
drugs today. There are numerous people who 
still believe that illness requires the immediate 
use of medicines and that there are some myster- 
ious or miraculous qualities in them which drive 
away the evil spirits of fever. 



The Malicious Medicine Habit 71 

Indiscretion in diet, overdrinking, careless 
habits and improper living cannot be corrected 
by taking the contents of the corked medicine 
bottle. As a matter of fact, the number of drugs 
which are considered as specifics for definite dis- 
eases may be counted on the fingers of one hand. 
It is, therefore, folly for the public to expect even 
a reasonable amount of benefit from some of the 
"cure-all" medicines v^hich are now upon the 
market. 

After all, medicines only play a minor part in 
the treatment of disease. They are the adjuvants 
or accessory agents which assist nature in com- 
bating the invasion of the disease-produting 
germs. They cannot act as substitutes for the 
common sense rules of rightful and healthful liv- 
ing. If such were the case, the study of medi- 
cine would be a simple science and health could 
be purchased in the drug store. This idea, how- 
ever, is often conveyed by many of the widely 
advertised remedies and cures for "lame back," 
kidney and stomach troubles, liver disorders, and 
various other common complaints. Of course, it 
pays to advertise, but a misrepresentation of the 
facts is unfair and very costly to the sick. In 
fact, the patient is given a false sense of security 
in the remedy purchased, while the disease may 
become progressively worse. 



12 The Malicious Medicine Habit 

We have all met in the course of our daily 
work men and women who constantly carry upon 
their person some form of pills, which they take 
religiously as though life were actually dependent 
upon them. It is true that the medicine fiend 
may obtain some relief from his habit pills, but 
such benefit is only temporary and is more likely 
mental than physical. It is certainly easier to 
take pills than to change one's mode of living, 
but sooner or later the medicine fails — perhaps 
too late to regain the physical strength lost 
through dissipation and careless habits. 

It should, therefore, be remembered that 
medicines are curative in only a small percentage 
of diseases, that the results of disregarding the 
laws of personal hygiene cannot be corrected by 
drugs, that health cannot be found in the patent 
medicine bottle, but that the simple life, good 
food, fresh air, sunshine and obedience to the 
well-recognized laws of rightful living are of 
more value than all the medicines combined. 



Misbranded Medicines Condemned 

nr^HE unsuspecting public has been the victim 
of medical cure-alls for many years, and 
patent medicines have become so numerous upon 
the market that they have become a serious men- 
ace to the public health. There are many people 
who still believe that health can be purchased at 
the drug store, and that patent medicines of un- 
known composition contain miraculous qualities 
in them which cure any and all disease. The 
health departments throughout the country and 
the entire medical profession are, therefore, unit- 
ing forces to break up this evil and to instruct 
the public in the dangers which lurk in many of 
the high-priced preparations of unknown com- 
position. The American Medical Association is 
now carrying on a vigorous propaganda for re- 
form, analyzing the various preparations placed 
upon the market and exposing their merits or 
demerits as the case may be. 

The Federal authorities have recently prose- 
cuted several manufacturers for misbranding 
drugs and have seized a number of falsely and 
fraudulently labeled medicines intended for in- 
terstate commerce. There were 4012 bottles of a 
certain patent medicine gathered up by the Fed- 
eral agents in Philadelphia only a short time ago 

(73) 



74 Misbranded Medicines Condemned 

because the labels on the bottles and pasteboard 
packages bore statements regarding its curative 
properties which were false and fraudulent. The 
manufacturers of this preparation claimed that it 
was efficient in the cure of consumption, coughs, 
colds, croup, asthma, bronchitis, sore throat, 
whooping cough and a number of other ailments. 
The court ordered that the goods should not be 
sold unless truthfully relabeled. 

A verdict of guilty was also rendered against 
a corporation in Philadelphia for shipping into 
interstate commerce a product which the manu- 
facturer claimed to be effective for dissolving 
gall stones, for curing diabetes and for relieving 
catarrh of the bladder. The Government alleged 
that the statements in the circular of this prepa- 
ration were false and fraudulent. 

There are, however, many more such frauds 
which are being worked upon the public. These 
are not only a financial loss to the people because 
of their high cost, but often endanger the life 
and health of persons who take these worthless 
preparations. The deceived victim is given a 
false sense of security by these untrue claims and 
often does not realize the danger until the disease 
has advanced too far for medical aid. 

Furthermore, the narcotic drugs and the 
amount of alcohol contained in many of the 



Getting Rid of Household Pests 75 

patent medicines are the basis of serious com- 
plaint against their constant use. The dangers 
of these, especially in persons already debilitated 
by disease, are clearly manifest. 



Getting Rid of Household Pests 

A FTER all rubbish has been removed and cob- 
webbed corners of the home cleaned out, 
the application of the following rules and recom- 
mendations will be effective and produce good re- 
sults in the elimination of house insects common 
during the warm season. 

Roaches: — Coal oil is one of the best agents 
for the destruction of roaches and their eggs. It 
should be sprayed freely by means of a machine 
oil can into the cracks and crevices of the floors 
and other woodwork where they breed. Pow- 
dered borax mixed with a little sugar is also a 
good remedy, but in the presence of other food 
borax is not very effective. It is suggested that 
cracks and crevices which are their hiding places 
be closed up with putty or paint. Since these 
pests hide by day and go forth at night to feed, 
it is essential that all foodstuffs be kept under 
cover and crumbs carefully swept from the floor. 



76 Gettirug Rid^ of Household Pests 

The kitchen sink should be scrupulously clean 
while the kitchen closets should be thoroughly 
scrubbed from time to time. 

Ants : — These little busy workers may readily 
invade the home. They can easily be destroyed 
by tracing them to their nests and pouring into 
them gasoline, benzine or coal oil. When using 
these substances, remember that they are highly 
inflammable. 

Fleas: — Human fleas, dog fleas and cat fleas 
are familiar household pests, the latter being the 
most prevalent. The larvae or embryo young of 
fleas live in the interstices of carpets, mattings 
and in the corners and cracks of floors. Since 
cats and dogs generally bring these pests into the 
home, care should be taken that these animals be 
kept thoroughly clean. Special rugs should be 
provided for them to sleep upon and the dust 
from the rugs burned. Hot water, soap and the 
scrub brush are very effective in destroying the 
pests which hide in the crevices of the floors. 
Here again gasoline is one of the best destructive 
agents. Carpets and heavy draperies should be 
dispensed with during the warm weather. 

Bedbugs: — Their presence does not always 
reflect upon the housewife, as they may be found 
in very carefully kept homes. A good way to 
destroy them is to spray their hiding places with 



Getting Rid of Household Pests 77 

a solution of corrosive sublimate (one ounce to a 
pint of alcohol). This substance is poisonous and 
should be so marked. Gasoline is one of the most 
efficient agents used in the extermination of the 
bedbug and should be sprayed freely in cracks 
and crevices with a machine oil can. Turpentine 
and kerosene are less efficient and leave oily 
stains after their use. 

Moths : — These are very destructive to clothes 
when not properly protected. Furs and woolens 
are particularly susceptible to the influence of 
moths. Thoroughly brush and clean the clothes 
before they are put away for the summer. Pack 
them in large paper bags or boxes which should 
be made air tight by sealing the edges with strips 
of paper. Wardrobes should be free of dust and 
thoroughly cleaned. Naphthalene or tar balls 
should be freely distributed in trunks, closets and 
in the pockets of clothes. It is also a good plan 
to unpack these clothes occasionally during the 
summer and give them an adequate airing in the 
sun. 

Flies : — Keep the garbage pail covered tightly. 
Fly paper freely distributed will be a great help in 
destroying them. A solution of potassium bichro- 
mate (one teaspoonful to two ounces of sugared 
water) or a few drops of formalin in sweetened 
water will kill flies, when placed where they can 



78 The Enemy at Home — The Fly 

drink. Fly swatters, fly traps and screens can be 
used to advantage. 

Mosquitoes : — Burning pyrethrum powder or 
sulphur will stupefy them. They then fall to the 
floor and can be burned with the sweepings. Do 
not allow any water to accumulate in barrels, 
pans, buckets, on the roof or any part of the 
house, as mosquitoes breed readily in standing 
water. 



The Enemy at Home — The Fly 

npHE fly is a dangerous carrier of disease. It 
sweeps down upon its victims like a hostile 
aeroplane, dropping bombs of disease among the 
civil and military population, leaving sickness and 
death in the wake of its onslaught. Nor does the 
damage cease with the death of the fly, for it has 
likely left behind enough eggs for a new gener- 
ation and these in turn give rise to many more, 
so that a single fly in the spring may be the 
progenitor of millions in the late summer. To 
combat the fly menace we must, therefore, swat 
each and every pest. We must also prevent its 
breeding. 

Garbage and manure are their chief breeding 
places. Every household should have a covered 



The Enemy at Home — The Fly 79 

watertight garbage pail in order to eliminate the 
possibility of breeding. Owners of stables are 
urged to keep their places in a clean and orderly 
manner and avoid exposure of the manure. 
Stable pits should be fly- and water-proof. Pow- 
dered borax should be sprinkled over manure 
which cannot be placed under cover. 

The housekeeper can assist materially in com- 
bating the fly nuisance by observing the following 
measures : 

Screen all doors and windows early in the 
spring. They are the barbed wire fencing 
against the hostile fly. 

Each home should be equipped with a fly 
swatter. Fly traps are also effective and are 
recommended. Fly paper can be used with good 
effect. 

All foodstuffs should be kept under cover. 
Sweets especially attract flies. The fly may 
readily convey infection by contamination of the 
milk. This essential food product should be re- 
tained in bottles or in covered receptacles. 

The kitchen sink should be kept free of fruit 
and vegetable parings. Soiled kitchen towels and 
napkins should be placed in drawers. 

Remove all food left over after meals. Col- 
lect the soiled dishes from the table as soon as 
possible, and see that they are washed promptly. 



80 Damage Caused by Rats 

Keep the ice box clean and free from odors. 
Garbage should be kept in a watertight and 
covered receptacle. 



Damage Caused by Rats 

O ATS are looked upon as a menace to the 
public health because they are likely to dis- 
seminate bubonic plague, or other disease. They 
should be thoroughly exterminated, not only for 
sanitary reasons, but also for economic purposes. 
They have never been of any use except possibly 
as scavengers in disposing of garbage. While 
people in cities are well acquainted with the 
ravages of rats in homes and stables, they see^i 
to know little about the damage caused by 
rodents in the fields. In summer, rats and even 
house mice live almost entirely upon the farmers' 
crops. 

The corn crop is most favored by rats. They 
are fond of the corn in the milk stage and often 
climb the upright stalks and strip the cobs bare. 
Extensive losses have been incurred in this way 
and fields have been made barren by them. 
Stacked grain and the feedbin are places of lux- 
ury for them. Breweries are often infested with 



Damage Caused by Rats 81 

these pests which are very fond of malt. Fruits 
and vegetables are frequently attacked by them 
during transit from various ports, thereby caus- 
ing much annoyance to dealers. 

They are the greatest enemies to poultry, since 
they prey frequently upon small chicks while in 
their nests at night. Young ducks, turkeys and 
pigeons are also likely to be attacked by them. 
Eggs are also a choice food. A merchant in 
Washington, D. C, stored loo dozen of eggs in a 
wooden tub in his warehouse and two weeks 
later, discovered that rats had gnawed a hole in 
the tub and had carried away 72 dozen of them. 
Young pigeons and squabs are also frequently 
killed by rodents. 

They are said to destroy the nests of wild 
ducks, woodcock and other marsh birds. The 
nests of ground-nesting and other song birds are 
often robbed of their eggs. 

No garden vegetable or common fruit is ex- 
empt from their appetite. They live on ripe 
tomatoes, cantaloupes, squashes, pumpkins, mel- 
ons and many other vegetables. They even climb 
vines to obtain the grapes and berries. They are 
fond of apples, pears, cherries, oranges, figs, 
dates and cocoanuts. The brown rat will readily 
climb the trees to obtain the fruit from the ex- 
tremities of the branches. They even make their 



^2 Damage Caused by Rats 

way through pipes and drains to get into green- 
houses. 

They attack seeds, bulbs, leaves, stems and 
flowers, and eat roses, carnations, geraniums and 
the choicest of flowers in stores and markets. 

They cause much damage by injuring dry- 
goods, clothing, books and leather goods which 
they seek for building their nests. Lace curtains, 
silk handkerchiefs, linens, carpets and mattings 
are often damaged by them. 

They also cause fires by carrying matches oft* 
to their nests where combustible materials are 
usually accumulated. Actual gnawing of the 
matches as well as friction and heat may cause 
them to ignite. They commonly cause fires by 
destroying the insulating covering of electric 
light wires under floors and between walls of 
buildings. It is the parafiin used on the insulat- 
ing fibre which attracts their attention. 

Each rat causes an approximate damage of 
$i.oo per year, and since it is estimated that there 
are as many rats as there are people, the total 
cost of their support in cities amounts to a large 
sum. The public is, therefore, urged to make a 
united campaign against these expensive pests, 
as their destruction will eliminate the possibility 
of disease from this source and will result in a, 
big saving to the community. 



Damage Caused by Rats 83 

HOW TO GET RID OF RATS. 

Rats are numerous where food exists in 
abundance and where they can find suitable 
breeding and nesting places. In the extermina- 
tion of them, therefore, it is of first importance 
to keep the house and premises free from any- 
thing rats can eat (except, of course, in places 
not accessible to them) and to exclude them from 
places where they can find food and a safe retreat 
for rearing their young. If such precautions are 
not taken, poison, traps and other means of de- 
struction give very poor results. 

Campaigns against rats, to be effective and 
lasting, must aim not only to destroy the greatest 
possible number of those living, but, what is more 
important, must prevent the possibility of fur- 
ther breeding and the ingress of rats from other 
localities. Experts agree that the only way to get 
rid of rats permanently is to ''build them out of 
existence." (See page 84.) 

Rats may be destroyed by trapping, by poison- 
ing, and by natural enemies, such as the cat and 
dog. 

TRAPPING THE RAT. 

In the use of any kind of traps, it should be 
borne in mind that the rat is extremely cautious 
and is frightened by anything in the least out of 



84 Damage Caused by Ruts 

the ordinary from his usual environment. Place 
the trap where the rat usually goes for food and 
change the surroundings as little as possible. In 
daylight, the rat's vison is somewhat defective, 
and he depends on his vibrissae to guide him. 
For this reason, rats avoid large open places and 
run along side walls or in narrow runways. 
Traps, therefore, should not be placed in open 
places, but in narrow runways or close to a wall. 

The bait in the trap should always be adapted 
to the surroundings in which the trap is placed. 
It should be some odorous article of food which 
the rat is not in the habit of getting. For ex- 
ample, where grain is plentiful the best bait is 
meat or fresh vegetables. The bait should be 
changed frequently. The following varieties of 
food make good bait : fish, fish heads, raw meat, 
cheese, smoked fish, fresh liver, cooked corned 
beef, fried bacon, apples, carrots and corn. 

Before being set, the trap should be dipped 
in boiling water or smoked with a piece of burn- 
ing newspaper to kill the smell of human hands 
or rats which have been previously caught in it. 

BUILDING THE RAT OUT OF EXISTENCE. 

Valuable as are all methods of rat slaughter 
for repressing the rat, it must be remembered 
that at best they are only partial and temporary 



Damage Caused by Rats 85 

in their effect. It is rarely possible to destroy all 
the rats on the premises by such means. Even 
when this is accomplished, they are soon replaced 
by other rats from neighboring places as long as 
the premises furnish an ideal feeding and nesting 
place for them. 

As stated above, the only way to get rid of 
rats permanently is to "build them out of exis- 
tence." This is best done by use of concrete or 
cement in all construction work. Old cellars may 
be made rat-proof at comparatively small expense 
by the judicious use of cement. Rat holes may 
be permanently closed with a mixture of cement, 
sand and broken glass or sharp bits of crockery 
or. stone. The principle is to allow no opening 
or crevice of any kind within which rats may 
nest or find protection from their natural ene- 
mies. 

Plank sidewalks in back yards, the throwing 
of old boxes in the basement, or the piling of old 
lumber or refuse around will supply shelter for 
rats and furnish a safe retreat for breeding pur- 
poses, so that the rat nuisance will continue even 
though buildings are amply protected. 

The concreting of the floors and walls of 
basements and the removal of plank sidewalks 
replacing them with cement stones or bricks have 
the additional advantage of excluding dampness 



86 Damage Caused by Rats 

from the house and contributing to the general 
cleanHness and sanitary condition of the premises. 

In dwelHngs infested with rats, wire screen 
compartments should be used for storing food. 
Flour, seeds, meats and the like should be kept 
in wire cages. Ice boxes and cold storage rooms 
should be made proof against rats by an outer 
covering of heavy wire netting of not more than 
half-inch mesh. Basement windows and other 
openings should be screened or raised above the 
ground. 

Where concrete is impracticable, the elevation 
of the floors above the ground to a height suffi- 
cient to permit free access to the natural enemies 
of the rat is an effective aid in the work of ex- 
termination. 

Since much of the rat's food consists of gar- 
bage and other waste material, it is not enough to 
bar the rat from the cellar, pantry and private 
food stores. Garbage and offal of all kinds must 
be disposed of so that rats cannot make use of 
them for food. Such things should be collected 
in covered metallic receptacles, which should be 
frequently emptied and kept tightly closed and 
clean at all times. Small amounts of food scat- 
tered upon the floors or on the ground over the 
premises will attract and feed rats even if the 
main supply of food be hidden. 



Bedbug a Carrier of Disease 87 

Slaughter houses, butcher shops, grocery 
stores and stables should receive the same careful 
attention as dwellings and should likewise be 
made rat-proof, if we are to be permanently rid 
of this dangerous and destructive pest. 



The Bedbug as a Carrier of Disease 

T^HE ridicule and fun poked at the bedbug 
should not obscure the important and ser- 
ious part which it plays in causing disease. It 
should be placed in the same class with the fly, 
mosquito, flea and louse as a menace to public 
health. 

Aside from such tropical diseases as Kala- 
Azar (a fever of India) and relapsing fever, the 
bedbug is credited as an agency for the transmis- 
sion of typhoid fever, scarlet fever, smallpox, 
bubonic plague, measles, infantile paralysis, lep- 
rosy and venereal disease. 

It is one of the oldest associates of man and 
its presence in the home need not mortify the 
housewife as she is not always blameworthy. It 
may get into the traveler's trunk or satchel from 
a hotel or sleeping car and may invade the home 
through the laundry or on the clothing. It 



88 Bedbug a Carrier of Disease 

travels from house to house and may make its 
home in one place and seek its food in another. 
When the hungry insect is deprived of its usual 
boarding house, as when residents move from 
their homes, it will migrate through a hole in the 
wall, along the plumbing, or over a roof gutter 
in search of substance. It thrives best in un- 
clean houses, in the cracks and even crevices of 
beds, underneath loose wall paper, on mouldings 
and on picture frames. Chicken houses are 
frequently infested with this pest. It is found 
on ships and trains, and seems to regard neither 
heat nor cold, but is not particularly active 
during the winter season, when it may go into 
hibernation. 

Because of its prevalence and its methods of 
travel, it is only fair to state that the presence of 
the bedbug is not a disgrace as its access to the 
home may be merely accidental, but its continued 
presence in the house means a disregard for 
health. Originally bedbugs had wings which 
have degenerated into little scale pads that are 
useless for locomotion; but their slow and sure 
migration by the use of their six legs seem to 
compensate for the loss of the wings. While bit- 
ing, the bug anchors itself to the skin and inserts 
its gutter-shaped jaws into the victim's skin, ex- 
tracting blood and injecting its own saliva. In 



Bedbug a Carrier of Disease 89 

this manner the bedbug may transfer organisms 
of disease from one person to another. 

The eggs are small and somewhat rounded 
white objects and are laid in collections in cracks 
and crevices. Little worms called larvae hatch 
out in about a week or ten days. These are yel- 
lowish white in color, but later become almost 
brown. After feeding they go into a resting 
state from which they emerge as pupae. They 
then shed their skin five times and finally become 
full grown adults. The length of time this de- 
velopment requires varies with the warmth and 
food supply from 7 to ii weeks. 

Bedbugs are hard to get rid of. First find 
their hiding place and destroy it. Loosened wall 
paper may have to be taken from the walls or 
pasted fast. Gasoline may be injected by an 
atomizer, brush, or feather into cracks and crev- 
ices, always remembering that it is inflammable. 
It will destroy both the adult bugs and the eggs. 
By far the best agents are the scrubbing brush, 
soap and hot water, to which may be added wash- 
ing soda or lye. Insect powders are not partic- 
ularly effective. Oil of turpentine, coal oil, or a 
solution of one ounce of corrosive sublimate 
(poison) to one pint of alcohol may also be used 
in destroying these pests. The common cockroach 
and little red house-ant are the natural enemies 



90 Germs Useful in .t'he Industries 

of the bedbug. When the house is overrun with 
bedbugs, fumigation by sulphur is very efficacious. 



Germs Useful in the Industries 

TN educating the people on matters of public 
health, the danger of germs in their relation 
to disease is emphasized frequently in order to 
impress the reader. As a result, it is often er- 
roneously concluded that the very air we breathe 
and the food we eat are always contaminated 
with disease germs. However, it is a relief to 
know that all germs do not cause disease, and 
that only a few of them have harmful effects 
and then only when they successfully combat the 
resisting power of the human body. Further- 
more the bacteria which cause disease are the 
most difficult to cultivate and with few excep- 
tions are very readily destroyed by the natural 
elements — sunlight, heat, cold, drying, dissem- 
ination by wind and by the water in streams. 

Many bacteria are very beneficial and are 
used to advantage in many ways. The fertility 
of soil depends in a large measure upon the 
action of bacteria. The disposal of all sewage 
and waste of animal and vegetable origin is made 



Germs Useful in the Industries 91 

effective by the action of bacteria, which break 
up the complex, compounds into their original 
elements. This natural process of decomposi- 
tion of dead organic material, known as nitri- 
fication, has a particular significance in prevent- 
ing soil pollution and in furnishing food for plant 
life. Without these nitrification bacteria in the 
soil, plant food and therefore animal food would 
cease to exist. No better example of their bene- 
ficial influence can be illustrated than the part 
which they play in the filtration of the water 
and is explained as follows: 

After the water receives its preliminary 
treatment, it is brought in contact with the filter 
beds of sand. As the water trickles between the 
fine granules of sand all the solid particles and 
most of the bacteria are left behind on the sur- 
face of the filter. An accumulation of bacteria 
and decomposed debris upon the filter bed forms 
a thickly woven network or sieve. The efiiciency 
of the filter is largely dependent upon this newly 
formed bed of bacteria called the ''Schmutz- 
decke," which catches the solid organic material 
in its meshes, where it is decomposed and broken 
up into fine particles. The best kind of filtered 
water is obtained from this slow sand process 
which is both biological and mechanical in its 
action. 



92 Germs Useful in the Industries 

The making of wine depends upon the action 
of bacteria for the process of fermentation, while 
beer, cider and vinegar also owe their existence 
to the work of these little forms of vegetable life. 
The baking of bread would be seriously inter- 
fered with if it were not for the action of yeast, 
a variety of bacteria which impart the quality of 
lightness and palatability to the bread. Without 
them sauerkraut, dill pickles and many other 
table delicacies would not be known. Milk and 
cream are soured by them, resulting in such pro- 
ducts as thick milk, sour cream, cheese, butter- 
milk and butter. The proper preparation of 
hides for the leather industry and the curing of 
tobacco are also largely dependent upon the action 
of bacteria. 

In medicine they are used in the treatment of 
disease in the form of vaccines and antitoxins. 
Even in the process of digestion they play an im- 
portant role. Thus it is shown that there are 
beneficial bacteria as well as harmful ones. Some 
bacteria require the association of others for 
their successful growth, while many are detri- 
mental to each other. It is fortunate indeed that 
the beneficial bacteria survive the harmful ones. 



Diseases Associated With the Soil 

T^HE soil was at one time believed to be one 
of the most important sources of the spread 
of the various infectious diseases. It was re- 
garded as the resting place of such diseases as 
tuberculosis, typhoid fever, malaria, yellow fever 
and many other communicable diseases. Our ad- 
vanced knowledge on sanitation, however, has 
revealed the fact that there are comparatively 
few germs dangerous to health which live in the 
soil and practically none which actually grow and 
reproduce there. 

There are, however, countless numbers of 
bacteria which harbor the upper surface of the 
soil, but these are beneficial and enrich the soil, 
making possible the growth of plant life, and 
enabling the earth to digest or assimilate all dis- 
carded animal matter. Without this natural 
property, we would be deprived of all our vege- 
table supply and mother earth would be littered 
with dead animal material. 

The disease-breeding bacteria, which may 
come in contact with the soil, are usually en- 
meshed by the upper layers of the earth and 
killed by the more active and more plentiful soil 
bacteria. There are times, however, when the 
soil becomes , polluted by human excrement 

(93) 



94 Diseases Associated With the Soil 

through careless measures of sanitation, or the 
lack of such measures, and then becomes a great 
source of danger, either by pollution of the water 
supply or by contamination of vegetables grown 
upon infected soils. Cholera, typhoid fever and 
dysentery may be caused in this manner. 

There are also organisms which, because of 
their resistant properties, may remain in the soil 
for some time and when, through accident, they 
are introduced into an abrasion of the skin or a 
wound may be responsible for such diseases as 
tetanus, malignant edema, anthrax and blood 
poisoning. 

There may be some relation to the moisture 
of the soil and tuberculosis, but this connection 
is most likely an indirect one. Exposure to the 
influences of a cold and damp soil depresses the 
vitality and lessens the resistance to tubercu- 
losis. It may also predispose to rheumatic affec- 
tions and to acute respiratory diseases. As an 
actual carrying agent of disease, however, the 
soil plays but a minor part and aside from the 
dangers encountered by pollution through lack 
of proper sanitary measures, there is a general 
tendency to belittle the influence of the soil upon 
health. . 

In the cities, where the soil is largely under 
cover of paved walks and streets, we meet with 



Keeping Cool in Hot Weather 95 

the problem of street soil or common dust which 
becomes a potential danger to the health, because 
it contains particles of organic waste, manure 
and vegetable debris, which is often laden with 
germs pathogenic to man. The abatement of 
this source of disease is a large problem of sani- 
tation and requires the co-operation of all the 
authorities, all health and civic organizations, 
and the public at large to bring about any ap- 
preciable result. 



Keeping Cool in Hot Weather 

LJEAT stroke and heat exhaustion are often 
fatal conditions. They take their toll 
chiefly among infants and the aged. Not infre- 
quently adults of middle age succumb to influ- 
ences of high humidity and temperature. Fatal 
cases among adults are usually the result of care- 
lessness upon the part of the individual in guard- 
ing himself from excessive and prolonged ex- 
posure to the sun's rays. 

Babies must be given special attention during 
the heated term. Mothers living in closely built 
up quarters, in tenements and in courts should 
keep their infants in rooms which are shaded and 



96 Keeping Cool in Hot Weather 

ventilated on the ground floor of the house. The 
top floor is usually very warm, more especially 
during the evenings after the sun has heated the 
roof of the house. Whenever possible, babies 
should be kept outdoors on the shady side of the 
street or in areaways unexposed to the sunlight. 
The baby's clothing should consist only of a loose 
cotton wrap, the arms and legs being bare. Bathe 
the baby daily. 

Persons of advanced years should not walk 
the streets during the heat of the day. They 
should seek the parks, the public squares and 
such shaded places outdoors which will afford 
them comfort and relief. Aged persons should 
not work outdoors at laborious trades requiring 
exposure to the heat. 

Among the vast majority of workers engaged 
at their usual pursuits, a great deal qI comfort 
may be procured if the proper kind of loose* light 
weight clothing is worn. Dark clothes absorb 
the heat rays and tend to make the individual 
warm. White or light colored clothing is cool 
and comfortable. 

An oflice with' suppressed soft light appears 
cooler than one brightly illuminated and receiv- 
ing the full glare of the sun. Indoor workers 
can make themselves very comfortable by wear- 
ing loosely woven cotton or silk undergarments. 



First Aid to Heat Victims 97 

Don't work too fast. Hurry and excitement 
tend to exaggerate the intensiveness of the heat. 
Avoid working on the sunny side of the street 
during the afternoon hours when the temperature 
of the day is usually at its height. 

Keep occupied and don't discuss the weather 
constantly. The thirst may be quenched by cold 
weak tea or lemonade slightly sweetened. 

Bathe daily. A cold shower after working 
hours and a change to clean clothing are very 
refreshing. Sleepless nights may be avoided by 
taking a cold sponge bath before retiring. Bed- 
rooms exposed to the sun may be closed tightly 
in order to shut out the heat of the day and then 
reopened at sundown. 



First Aid to Heat Victims 

TN order to give proper aid to persons over- 
come by the heat, it is first essential to dis- 
tinguish between sunstroke and heat exhaustion, 
which are the two- forms of symptom groups pre- 
sented by excessive heat and high humidity. 

In the case of sunstroke, the patient first com- 
plains of a tired feeling accompanied by a sense 
of oppression in the head. Dizziness followed by 



98 First Aid to Heat Victims 

unconsciousness may soon follow. The face is 
deeply flushed, the breathing labored and the skin 
is dry and hot. The pulse is irregular and weak. 

The symptoms of heat exhaustion resemble 
very much those of sunstroke at the onset. The 
skin in this case is cold and clammy and the body 
temperature is below normal. The patient may 
succumb quickly if proper treatment is not ad- 
ministered. 

The first aid treatment rendered to a heat 
victim should be to remove him to a cool shady 
place arid to loosen his clothing. One should 
next ascertain whether the surface of the skin 
is hot or cold. If the former, the patient should 
be sponged immediately with ice water. When 
removed to a more favorable place indoors, a 
plunge in a tub of cold. water should be given. 
Ice cold cloths or an ice cap can be applied to 
the head. As soon as consciousness is regained, 
cold drinks may be given freely. The patient 
should be kept in a quiet and cool room. 

Heat exhaustion, on the other hand, calls for 
rapid stimulation. By touching the skin of the 
patient and finding it cold and moist, we can 
readily come to the conclusion as to treatment. 
The patient should be covered immediately with 
blankets, and hot water bottles applied to the 
feet. Hot drinks such as tea, coffee or lemonade 



Hints for Bathing and Boating 99 

should be administered if the patient is conscious. 
Aromatic spirits of ammonia placed on a bit of 
cotton may be held near the nostrils of the 
patient. 

Every effort should be made to have the pa- 
tient sent to a hospital at post haste speed where 
the facilities for treatment are the best. Out- 
door laborers should wear proper headgear to 
protect the head from the sun's rays. 



Safety Hints for Bathers and Boating 
Parties 

npHE attraction of the water during the sum- 
mer calls to mind the numerous accidents 
and fatalities which are reported each year from 
the various pleasure resorts throughout the 
country. A timely warning is therefore issued to 
aquatic enthusiasts to exercise reasonable care 
and judgment when bathing or boating. In 1915, 
one hundred Philadelphians lost their lives by 
drowning — a mortality greater than that of scar- 
let fever and whooping cough combined. Since 
many of these deaths were due to carelessness 
and daring on the part of pleasure seekers, a few 
words of caution during the height of the vaca- 



100 Hints for Bathing and Boating 

tion season should serve the good purpose of pre- 
venting avoidable accidents. 

There is a tendency on the part of many 
people to stay in the water too long, while others 
overestimating their abilities as swimmers, find 
themselves quite exhausted after long swims, thus 
increasing the possibility of accidents by drown- 
ing. Bathing after a heavy meal, cold plunges, 
or exhaustion may cause muscular cramps which 
are ofttimes responsible for accidental deaths. 

Those who are troubled with heart disease, 
hardened arteries or poor kidneys are warned 
against long exposure in the water or taking cold 
plunges. The bloodvessels of the surface of the 
body contract under the influence of cold, and 
the heart in an effort to force the blood through 
these contracted vessels, fails if unequal to the 
added strain. 

"Rocking the boat" and other misconduct of 
sailing parties are often responsible for mishaps 
on the water. All pleasure boats should, there- 
fore, adopt strict rules of discipline and carry a 
sufficient number of life belts for passengers. 

A little knowledge of the first aid treatment 
for the apparently drowned may prove of great 
value to every vacationist. A recognized method 
of procedure is as follows: As soon as the vic- 
tim is brought ashore, loosen the clothing about 



Hints for Bathing and Boating 101 

his neck. The body is then turned face down- 
ward. Standing astride the victim, clasp your 
hands about the abdomen and raise the body 
somewhat from the ground. This act tends to 
expel the waiter from the stomach. The person 
is then turned on his back, the head turned to one 
side and the tongue drawn forward to avoid in- 
terference with the respiration. Kneeling on one 
knee at the victim's head, grasp both arms just 
below the elbows, and with an outward sweeping 
motion draw them away from the body, raising 
the arms above the head. This causes inspiration 
by drawing the ribs outward. The arms are 
then brought down and the elbows pressed 
against the lower ribs with sufficient steady force 
to expel the air from the lungs. This should be 
repeated at the rate of i6 times per minute and 
continued until normal respiration returns. One 
or two hours of artificial respiration are some- 
times required to revive the apparently drowned. 
The victim should be wrapped in warm dry 
blankets and the legs and arms massaged to en- 
courage circulation. Stimulants should be ad- 
ministered preferably by a physician, and the 
lungmotor or pulmotor should be reserved for 
one skilled in their use. 



(( 



Dog Days' 



npHE lower animals may become affected by 
the heat just as human beings. Our most 
intimate pet — the dog, may become irritable dur- 
ing the hot weather and run amuck among pedes- 
trians causing the cry of ''mad dog." This may 
account for the erroneous belief that dogs are 
more apt to go mad during the heated term. As 
a matter of fact, the disease known as rabies 
affects dogs at any time of the year and in any 
climate. Irritable dogs, however, are not neces- 
sarily rabid ; nor does every dog bite cause hydro- 
phobia. It is nevertheless essential that all in- 
juries inflicted by dogs be considered potentially 
dangerous until they are proved to be otherwise. 
The disease known as hydrophobia in man 
and rabies in the lower animals, is caused by a 
poisonous virus which is introduced into the body 
by the bite of a rabid animal. The dog is a 
common offender. Cases are on record in which 
the infection has resulted from the mere licking 
of wounds or scratches on the hands or face of 
children by apparently harmless dogs. 

FIRST AID TREATMENT. 

The first and foremost thing to do when bit- 
ten by a dog is to have the wounds thoroughly 
(102) 



'Dog Days" 103 



cauterized by a physician. This should be done 
as soon as possible in order to prevent the ab- 
sorption of the poisonous virus. Special atten- 
tion should be paid to injuries about the head 
and face as the greatest number of fatal cases 
result from bites at these parts of the body. 
Home remedies are ineffectual and only delay the 
proper treatment. 

The offending dog should be caught and kept 
under observation for symptoms of rabies. If 
the animal is infected, the disease will develop 
in a short time, and will cause its death within a 
period of ten days. It ofttimes becomes neces- 
sary to kill the animal in the attempt to catch it, 
and to protect other persons from being bitten. 
In such event, one should avoid mutilation of the 
head and back because the diagnostic signs of 
rabies are found in the brain and spinal cord, 
and it is desirable to have these organs intact 
when under examination. The police will assist 
in apprehending the offending animal and re- 
move it to the proper authorities for observation 
and examination. 

If it is found that the dog does, not have the 
rabies, then no harm has been done by the cau- 
terization of the wounds; but if evidences of the 
disease are found, then the patient should receive 
the Pasteur treatment without delay — this being 



104 Summer Resorts and Public Health 

the only recognized preventive measure to ward 
off the disease. The Pasteur treatment consists 
of a series of injections of a serum especially 
prepared for this disease. Since there is no cure 
for the disease once it develops, it is all-important 
that this treatment be given in all suspicious or 
doubtful cases. 



Summer Resorts and Public Health 

'TpHERE are two kinds of summer resorts 
from the standpoint of the public health 
official — those which permit comfort, ease and 
healthful environments and those which are fer- 
tile breeding places of disease, operating under 
the false pretense of fresh air country, seashore, 
river and lakeside resorts. Attention is more es- 
pecially directed to the latter class of pleasure 
and rest-seeking playgrounds. 

It seems that every type of farm house, no 
matter how dilapidated or unsanitary the sur- 
roundings may be, is brushed superficially of its 
winter dust and accumulations to accommodate 
the summer boarder. Thousands of city dwel- 
lers flock to such farm houses during the heated 
term to avoid the dust, the dirt and the noise and 



Summer Resorts and Public Health 105 

heat of the crowded home town, but only to be 
ushered into more crowded, dirtier and ofttimes 
filthy environments of the country boarding 
house. Surely such conditions as actually exist 
in some of the cheap country lodging houses 
which are placarded as hotels, are not even com- 
parable to the slums of our cities. 

In the congested sections of the larger cities, 
the water supply, sewage and garbage dis- 
posal, at least, are under expert sanitary super- 
vision. This is not so in many of our so-called 
country resorts scattered throughout the various 
states to which our residents readily flock during 
the vacation period. The country pump, unpro- 
tected from seepings from the outhouse, or from 
contamination round about it, has been con- 
demned time and again. The haphazard dis- 
posal of garbage unprotected from the disease- 
bearing fly, together with inattention to the 
mosquito-breeding rain barrel, all add to the ob- 
jections lodged against the unsanitary farm 
house. 

About 25 per cent, of the typhoid fever cases 
which occur in the eastern cities every fall are 
caused by infections among vacationists who visit 
such summer boarding houses as mentioned 
above. It becomes the duty therefore of the 
health authorities to warn the public against the 



106 Spoiled Meats and Ptomaine Poisoning 

possible spread of disease in overcrowded and 
unsanitary farm houses, more especially in re- 
ference to typhoid fever. 

The cheapness of the resort is ofttimes a 
guide to its sanitary conditions. It will pay in 
the long run to choose a large resort where ex- 
pert supervision of the health of the community 
is maintained by the local authorities. As long 
as the public remains indifferent to the sanitary 
conditions of the various summer resorts, so long 
will we continue to have our quota of typhoid 
cases in the fall, each of which may act as a dis- 
tributing focus of many other cases. 



Spoiled Meats and Ptomaine 
Poisoning 

TV/f EATS spoil very rapidly during the hot 
weather, especially if not properly pre- 
served by ice. The ingestion of partly spoiled or 
decomposed meat is responsible for a large num- 
ber of intestinal complaints in summer. Cook- 
ing, however, kills many of the poisonous germs 
and their toxins, but in some instances the toxic 
products are not destroyed in the process of cook- 



spoiled Meats and Ptomaine Poisoning 107 

ing and, therefore, may give rise to symptoms 
of ptomaine poisoning. This is particularly true 
of sausage, cooked meats which have not been 
kept cool, shell—fish and salads containing chop- 
ped meats. Some persons are very susceptible 
to the effects of foods with beginning putrefac- 
tion, while others may even show ill effects from 
fresh meats during the heated season, this being 
due to a peculiar sensitiveness to protein foods. 
Such persons should eat sparingly of meat during 
the summer. 

The sale and use of spoiled meats can largely 
be avoided if the housekeeper will learn to detect 
such foods as outlined in the following descrip- 
tions : 

Fresh beef should be of a rosy red color, with 
cream colored, firm, elastic fat, and scarcely 
moist when touched with the finger. Do not buy 
wet, flabby beef that is pale or purple. 

Lamb or mutton should be firm, close-grained, 
and light red in color with fat that is white and 
hard. 

Fresh veal is pale red (unless milk fed, when 
it is light) with firm white fat between the mus- 
cles surrounding the tissues, and scarcely moist 
to the touch. Bad veal is soft, mushy, sticky and 
has a very red tinge while the fat has a grayish, 
lead color. 



108 Spoiled Meats and Ptomaine Poisoning 

Good pork is solid, has pure white fat and 
pink flesh. Do not buy pork that is soft and 
yellow. 

Poultry should be firm to the touch, pink or 
yellow in color and possess a fresh odor and un- 
broken skin. Stale poultry is flabby, bluish green 
on the crop and abdomen and has a bad odor ; the 
eyes are sunken, there is a wasted appearance to 
the flesh of the head and the skin pulls apart 
easily. 

All shell-fish should smell fresh, and the 
shells should close firmly when put into water or 
touched with the finger. Shell-fish should be 
alive when cooked. 

Fresh fish should have red gills and moist 
bright scales, clear eyes, and should be firm and 
rigid when handled. Stale fish is flabby, has dull 
scales, the eyes are sunken and covered with a 
film, the gills are pale, or of greenish color, and 
the fish has a bad odor. All lumpy fish should 
be rejected as the growth may be cancer. 

To detect decomposing meats in cans before 
opening, inspect the ends of the can, and if they 
bulge, discard the can. This bulging is due to 
accumulated gases of decomposition that push 
the ends outward by force of pressure. Leaking 
and rusty cans should also be discarded. Canned 
meats should be free from mould. The odor of 



spoiled Meats and Ptomaine Poisoning 109 

such meats should be the same as when freshly 
prepared. If the meat is putrid exposure to heat 
will make it possible to detect the foul odor. 

Smoked meats, fish and glassed meat pro- 
ducts are bad when they have a rancid, sour 
smell, and when the color differs from the fresh 
product. 



PART III 
SUBJECTS FOR THE HOLIDAYS 



Don'ts for the Fourth 

T^ON'T use fireworks, pistols or explosives of 
any kind within one square of any hospital 
or other institution for the care of sick or injured 
persons, or of any dwelling where serious sick- 
ness exists. 

Don't forget that the nuisance created by 
unnecessary noises applies to the Fourth of July 
as well as to any other time. 

Don't sell or use toy cartridge pistols, toy 
cannons or devil bombs. The police have been 
instructed in many cities to suppress them. They 
cause most of the serious injuries. 

Don't sell or use fireworks containing picric 
acid, picrates, dynamite or other highly explosive 
compounds. They are dangerous to life and limb, 
and their sale or use is prohibited by law. 

Don't sell or use blank cartridge pellets or 
other tablets containing dynamite or other highly 
explosive compound. Their use in pistols, hol- 
aiO) 



Don'ts for the Fourth 111 

low canes or any toy for explosive purposes 
should be prohibited by law. 

Don't let the children have any kind of fire- 
works in their possession. Small firecrackers 
have large potential dangers. The supposedly 
harmless sparklers and lighted punk have caused 
fires that resulted in loss of life and property. 

Don't forget to teach the children that fire- 
works are dangerous play toys. 

Don't set a poor example for your children 
by shooting off fireworks for their amusement. 
A serious injury may permanently disable the 
careless parent and thus deprive his dependents 
of their only means of support. 

Don't let others bring fireworks into your 
home. If your neighbors persist in the use of 
aerial display in the form of sky rockets, Roman 
candles and fountains, it will be safer to close the 
windows and thus guard against the danger of 
flying sparks. 

Don't raise toy balloons. They are readily 
set on fire and often fall on places distant from 
their origin of ascent, and in this way may be a 
serious menace to the safety of valuable property. 

Don't have Japanese lanterns and other 
lighted decorations near inflammable material, 
or fail to keep a close watch on them during the 
period in which they are lighted. Swinging 



112 Health Hints for Christmas 

paper lanterns or colored tissue paper about elec- 
tric lights easily catch fire and should not be 
used. 

Don't fail to have all injuries from fireworks 
treated immediately by a physician. Lockjaw 
can only be prevented by prompt medical treat- 
ment. 

Don't forget that a safe and sane Fourth will 
serve to inspire patriotism and preserve the his- 
toric meaning of Independence Day far better 
than the senseless demonstration by the noise of 
gunpowder. 



Health Hints for Christmas 

CiNCE Christmas brings with it the spirit of 
happiness and good-will we must not forget 
to invite those in less fortunate circumstances, 
the sick and the distressed, to share in our re- 
joicing. An appeal to the public is, therefore, 
made to bring good cheer to the depressed and 
unhappy in the many hospitals. The sick need 
our sympathy, as it goes a long way to make 
their miserable lot less burdensome and to divert 
their thoughts from things depressing and 
painful 



Health Hints for Christmas 113 

The most appropriate gifts for hospitals and 
charitable institutions are flowers, greens and 
other seasonable decorations. These impart an 
air of freshness and cheerfulness to the hospital 
wards and are so pleasing to the patients as to 
give them a feeling of well-being. Fruit is also 
an acceptable donation for the sick, but candies 
and cakes are not often permitted. Books and 
games are always welcomed by convalescents and 
chronic invalids. It should not be forgotten that 
a personal visit is often more appreciated than a 
gift; and if the latter is decided upon, it is best 
to ask the patient's doctor or nurse what is suit- 
able. 

In selecting toys for your children, choose 
those which will take them outdoors where they 
can enjoy heathful exercise. This applies to girls 
as well as boys. Skates, sleds, toy wagons, 
tricycles and doll baby coaches are among the 
many playthings which entice the youngsters to 
seek the open air. While indoor games have their 
value, the children should be encouraged to play 
outdoors when the weather is fair and pleasant. 
The city's parks and playgrounds offer the re- 
quired facilities for play and just as many varie- 
ties of amusement in the winter as in the summer. 

Shot guns, swords and similar toys should 
not be entrusted to young children. Serious in- 



114 Health Hints for Christmas 

juries have resulted from such dangerous toys in 
the past. The shot from an air rifle has fre- 
quently penetrated the eye and destroyed its 
sight or perhaps caused its removal. 

Mechanical toys which require the use of 
alcohol, gasoline, headlight oil or any other in- 
flammable material are unsafe playthings. 

Christmas trees should not be adorned with 
lighted candles as the trimmings may readily 
catch fire. Paper decorations should be guarded 
against fire from overheated stoves. 

Do not permit the children to exchange their 
toys, especially those which are apt to be placed 
in the mouth, such as horns, whistles and mouth 
organs. 

Missions and charitable agencies which dis- 
tribute second-hand toys among the children of 
the poor are requested to have such toys disin- 
fected before they are given away, since some 
of them may have been used by children suffer- 
ing from infectious diseases. 

It should also be remembered that many 
children attend school poorly clad and that a 
gift of clothing would serve a better purpose 
than toys. 



Health Resolutions for the 
New Year 

\\/^ HERE AS one third of all the deaths oc- 
curring during the year were due to heart 
disease, pneumonia and tuberculosis, most of 
which could have been avoided or, at least, de- 
ferred, and 

Whereas sickness and pestilence can largely 
be abated by cleanliness, fresh air, good food 
and attention to the common sense laws of per- 
sonal hygiene, and 

Whereas disease germs have little or no op- 
portunity to grow or produce their poisons in a 
healthy body which closes all avenues of invasion, 
and 

Whereas the promotion and preservation of 
the public health are important functions of the 
Government, and 

Whereas good health is the very foundation 
of progress, efficiency, prosperity and happiness, 
and 

Whereas the public health is a purchasable 
commodity and personal health is property which 
can be held in safe keeping, 

(115) 



116 Health Resolutions 

Be it Resolved, That the pubHc be urged to 
adopt the following: 

To avoid excesses which tend to depress the 
vitality and encourage the invasion of disease. 

To adopt moderation in all things, more es- 
pecially as applied to foods and drinks. 

To keep regular habits. 

To sleep eight hours each day. 

To exercise at regular intervals. 

To observe the general laws of personal hy- 
giene. 

To go outdoors as much as possible. 

To ventilate the home, office and workshop 
in order to insure comfort, ease and healthful 
surroundings. 

To avoid places of assembly which are poorly 
ventilated and other overcrowded gatherings. 

To protect others from communicable dis- 
eases by avoiding expectoration on the sidewalks 
and in public places and by using the handker- 
chief when coughing or sneezing. 

To keep each and every foregoing resolution. 



PART IV 
MISCELLANEOUS TOPICS 



Health Day and its Significance 

'TpHE preservation of the national health is a 
patriotic duty. This statement was made 
by one of our leading statesmen ten years ago. 
Today its significance is fully appreciated. 

Health organizations have united throughout 
the country for the purpose of assisting the 
Federal authorities in the abatement of disease 
and the promotion of the public health. A special 
day is being set aside each year, known as 
"Health Day'' for the purpose of emphasizing the 
importance of good health. There is need, how- 
ever, of co-operation of each and every citizen, 
old and young, in this most important effort to 
improve the physical well-being of the country. 

Our first aim is to impress upon the minds of 
the younger and older school children the value 
of a well developed body and mind, the impor- 
tance of proper muscular physique and the ad- 
vantages of early correction of physical defects. 
A sound and healthy school population will be 
the nucleus of an adult population of great vital 
power. 

(117) 



118 Prevention of Physical Deformities 

Sedentary life among our older men and 
women has reduced to a certain extent their resis- 
tance to endurance and hardships. Those who 
have visited the countries abroad during the 
World War have impressed upon us the necessity 
of improved physique among persons of middle 
age whose services in the field have been valuable 
because of their mature judgment. A more 
active outdoor life is, therefore, urged for those 
of mature age. 

The Prevention of Physical Deform- 
ities a Vital Health Problem 

A REPORT of the United States Bureau of 
Census shows that over 53,000 infants died 
in this country in 19 14 from debility and deform- 
ities which were manifested at the time of birth. 
These fatalities comprised 6 per cent, of the total 
number of deaths from all causes. While these 
figures are apparently alarming, they only repre- 
sent the smaller proportion of the number of 
physically deformed children who live on in spite 
of their incapacities and form the basis of our 
enormous human scrap heap which sooner or 
later becomes a costly charge to the nation and a 
burden to the normal, productive and progressive 
human stock. 



Prevention of Physical Deformities 119 

The savages solved the problem of the physi- 
cally unfit by allowing nature to determine the 
survival of the fittest. In this civilized age, how- 
ever, we must resort to more humane, rational 
and more effective means of preventing the pro- 
duction of crippled and physically hampered off- 
spring. Here again a campaign of education 
directed particularly to the young men and 
women who are to be the prospective fathers and 
mothers of the coming generation should be the 
means of attacking the problem. The dangers 
of venereal disease and the hereditary influence of 
tuberculosis on the physical make up and power 
of resistance of children whose parents are so in- 
fected should be subjects for discussion. Club 
foot, hunchback, knock knee, bowlegs, distortion 
of the shape of the head, tubercular spine, hip 
joint disease and the various other abnormalities 
of the bony framework are defects which can, in 
most cases, be prevented. Injuries to the expect- 
ant mother and delay in securing the services of a 
physician during the confined period are all fac- 
tors which may enter into the dominant causes of 
physical abnormalities of the newborn. 

The necessity of having early attention paid 
to apparent defects of the child should also be 
impressed upon the young parent. Ofttimes 
children are permitted to reach adult life without 



120 Prevention of Physical Deformities 

any medical attention, when the possibiHties for 
a correction have probably passed. 

Persons who are knowingly infected with 
disease and thus capable of transmitting hered- 
itary influences owe it to themselves and to the 
human race to forego the right of parentage. 
Control of the feebleminded should be so exer- 
cised as to prevent the production of a like 
offspring. 

Furthermore the new act of legislation which 
compensates the workmen for injuries incurred 
in the line of duty and that which aims to protect 
children from dangerous occupations have caused 
employers to engage only those physically fit and 
in good health. Debarment from employment of 
the cripple other than the war cripple, the de- 
formed and the physically unfit makes the burden 
of an increasing human scrap heap more evident. 

It is a better plan to aim to prevent these 
deformities than to seek means of supporting the 
unfit and a campaign of education will have more 
effect than any legislation which might be 
suggested. 



Health of Women Wage Earners 

npHE opportunities in the industrial field for 
women have been so great that large num- 
bers have undertaken pursuits of gainful employ- 
ment. Thousands of women who, heretofore, 
have lived in idleness or were engaged in minor 
employments have joined the great army of 
workers in vital and important essentials of in- 
dustry. The factory, the munition shop, the farm 
and the military service have found female labor 
an invaluable adjunct in maintaining their maxi- 
mum output. 

The change of life from the home to the 
workshop however demands that the woman 
worker keep in good health and guard herself 
against the invasion of disease. In many of our 
states labor laws have been enacted to protect 
the female wage earner from hazardous employ- 
ments and have limited her working hours to 
preserve her physical strength. 

We are accustomed to look upon women as 
the "weaker" sex but experiments conducted 
among the college women in one of our universi- 
ties indicates that there is no difference in the 
muscular strength of men and women which is 
due to sex as such. The differences frequently 
found are attributable to the differences in the 

(121) 



122 Health of Women Wage Earners 

use of muscles brought about by the conventional 
Hmitations of activity or by dress. Experience 
has amply demonstrated that women can perform 
services requiring great physical strength and 
can perform the same with efficiency. The ques- 
tion arises whether such employment may in any 
way injure or interfere with her normal physi- 
ological functions. 

When employed under medical supervision, 
there is reason to believe that female employes 
are in no way incapacitated or subject to undue 
injury pecular to their sex. Married women how- 
ever must be given special care and employment 
denied them for a certain period prior to the 
lying-in state and for a definite period during 
lactation. 

Working girls are often subject to complaints 
peculiar to their sex which require the careful 
supervision of their personal hygiene and habits. 
Female wage earners are capable of great service 
when given rest periods during certain hours of 
the day and if permitted time for special outdoor 
exercise. Various establishments have already 
taken upon themselves the supervision of the 
health of these women wage earners as a part of 
their own responsibilities. Their protection from 
physical defects incident to employment is a valu- 
able and essential public health measure. 



Recreation and Health 

T^HE value of recreation and play as a natural 
incentive toward sound physical develop- 
ment and good health is no longer a disputed 
fact. Every large city in this country has recog- 
nized the importance of providing spacious 
grounds and indoor facilities for free exercise of 
youth's greatest desire — entertainment and pleas- 
ure. The impulse to play is just as natural and 
essential as the desire to eat or sleep. Prior to 
the establishment of playgrounds and recreation 
centres, children created their own places of play 
in the streets, in the alleys, about corners, in 
cigar stores and pool rooms. Crime and vice 
were the only open avenues for the youth who, 
as it seems, were crowded out and forgotten in 
our rapid and endless progress of civilization. 

We have learned, however, that the respons- 
ibility for wrong-doing among the boys and girls 
is not really theirs, but belongs to those who fail 
to provide for them safe, healthful and carefully 
supervised playgrounds for the outlet of their 
overflowing energies. A public playground takes 
care of that natural curiosity and disposition to 
play and do things, and exerts a beneficial effect 
not only upon character-building, but upon the 
moral and physical make-up of our youthful pop- 

(123) 



124 What Exercise and Recreation Mean 

ulation. It teaches self-restraint, fair play and 
good judgment, all of which are essential quali- 
ties toward good citizenship. 

The future welfare of our country depends 
upon the physical and mental education and moral 
character of our children of today. By teaching 
them fairness in play we are also teaching them 
fairness in war, with due respect to the rights of 
others. Such children are the men and women 
of tomorrow, who will insure the integrity of the 
home, the safety of the nation and the democracy 
of the world. 



What Exercise and Recreation Mean 
to School Children* 

T^HE great majority of people little realize 
what physical education means, not only in 
child life, but to the life of both men and women. 
During the war, officers in charge of training 
camps realized how much "setting up" exercises 
meant to the physical efficiency and stamina of 
the men, and so we, whether teachers or parents 
should look well to the physical education of the 

* Courtesy of Violet Whittaker Mange, Principal of Municipal 
Recreation Centre, Bureau of Recreation, Philadelphia. 



What Exercise and Recreation Mean 125 

children, and here education is used with full 
emphasis. 

To the school child exercise means only run- 
ning, romping and playing games ; but to trained 
workers, a specific course is mapped out with a 
view to bringing into play all the large groups 
of muscles and increasing organic vigor. Every 
child should take this training, and whenever 
possible the lesson should be given in the open 
air as its value is thus increased ten per cent. 
The lesson should consist of tactics, free hand 
drill, with arm and leg movements, trunk bending 
and twistings, ending with a good vigorous 
game. 

This form of work can be made more or less 
attractive to the child, by the personality of the 
director, who in turn can urge the child to per- 
form the exercises given on rising in the morn- 
ing and before retiring. No vigorous exercise 
should be taken directly after eating a hearty 
meal, nor yet on an empty stomach, and it is 
always to be borne in mind that exercise is of 
little value unless systematically performed. 

School children should be allowed a certain 
amount of free play on apparatus in the school 
yard or unsupervised games. This form of exer- 
cise may be best sought before the opening hour, 
and when practical, at intervals during the school 



126 What Exercise and Recreation Mean 

period, especially in the case of younger groups. 
During the morning session the physical director 
should supervise all games and exercises, putting 
the classes through the regularly worked out 
course of study, which beginning with the A, B, 
C of the work takes the child through, until each 
muscle has been so trained that upon reaching 
early man or womanhood we have an all around, 
sound physical development. After school hours 
the children should have competitive games and 
athletics, taught and coached by the instructor, 
so that the child leaves school in a vigorous 
physical condition, and happy frame of mind. 

A child thus trained, and who later, of its own 
volition, continues to indulge in strenuous ath- 
letic games, can perform them as well as heavy 
apparatus work, with agility and lack of fatigue 
until after the age of fifty has been reached. 

Another important feature of the physical 
director's task among school children, is correc- 
tive work ; exercises being given largely for round 
shoulders, drooping of either shoulder, flat foot 
and constipation. The directions, written out, 
should be taken home by the children where the 
parents should insist that they be faithfully 
followed. 

No thought of exercise may be held that does 
not include walking and swimming, and none is 



What Exercise and Recreation Mean 127 

more generally beneficial. No recreation, despite 
the form it may take is real unless it means men- 
tal stimulation, rest to the nervous system and 
general relaxation. 

As all education is only a means of fitting 
one to meet all conditions of life, making for 
clear judgments and bringing out the best in 
each; it can readily be seen how great an oppor- 
tunity the physical director has not only to de- 
velop a strong healthy body, but to bring forth 
such traits as self-control, determination, loyalty, 
unselfishness, fair play and leadership, all of 
which characteristics can be taught through 
games and athletics. Therefore these habits are 
absorbed unconsciously in childhood through this 
play method, and later produce men and women 
of character who will stick to the ideal no matter 
what pressure may be brought to bear upon 
them. 

See that your children have physical educa- 
tion. 



Exercise and Recreation for the Busy 
Man or Woman* 

npHE adult question is one of the big problems 
that confronts the recreation leader. How 
to attract the busy man and woman to any organ- 
ized form of exercise is the big question, for there 
are so many side lights to entice in any large 
city. However, let us suggest first something for 
men, dividing them into the sedentary worker, 
and the man whose business keeps him on the 
jump all day. 

It is fair to suppose that both these types had 
no physical education in childhood, for this is a 
comparatively new phase of school life, therefore 
their muscles are untrained, developed perhaps 
but not scientifically so. 

The active man is naturally more vigorous, 
his muscles are in better tune, and he could, 
because of this, accomplish more, make more 
progress in organized gymnastic work, than the 
sedentary or less active man. Usually, however, 
this form of recreational exercise does not make 
a strong enough appeal. He prefers no set form 
of work, and if he does go to a gymnasium he 



* Courtesy of Violet Whittaker Mange, Principal of Municipal 
Recreation Centre, Bureau of Recreation, Philadelphia. 

(128) 



Exercise and Recreation for Busy Adults 129 

may do a little work on the apparatus, run a little, 
play some short snappy game, and then enjoy 
taking a shower. Usually it is best to offer men 
of this type a game of pool, a little "bout,'' or 
seasonable conditions permitting, a game of 
tennis or a swim. 

Recreation centers provide all the facilities 
whereby these activities are made possible; 
trained workers are provided, social gatherings 
of all kinds are possible, dances are run, clubs 
organized and lectures from time to time are 
given. There is something for everybody. 

As to the sedentary worker, his form of 
activity should be along formal gymnastic work, 
for the reason that the physical director will give 
just enough in a lesson to make the unused mus- 
cles relax, but not enough to overtax and cause 
fatigue. A man who sits at his desk all day 
needs some form of exercise to increase circula- 
tion and respiration, and often to reduce any 
surplus fat he might have acquired. 

As to the question of exercise for women; 
almost any woman, no matter what her work, 
would be benefited by joining a "gym" class and 
going through the prescribed course of lessons 
covering a fall and winter term. It has been 
proven time and time again that if a young 
woman comes home from the mill, factory or 



130 Vacant Lots or Gardens 

office awfully tired, an hour spent in the gym- 
nasium will so change the thought current be- 
cause of bodily activity of a different nature than 
she expended while at work, that the draggy, 
tired feeling entirely leaves her, and the full 
benefit of sleep will be obtained. Compare this 
form of recreation to an hour spent in the 
"movies/' 

Recreation is not recreation unless it makes 
for joyousness and really re-creates the person 
indulging in whatever form appeals to the partic- 
ular personality. 



Vacant Lots or Gardens 

T N the last few years every effort has been made 
in the interest of food conservation and pro- 
duction, for the utilization of all vacant lots as 
gardens. Our efforts were not unrewarded for 
thousands of dollars worth of produce was 
gathered in our home-made gardens. The Gov- 
ernment has advised that these back yard farms 
be continued as a measure of home economy. 
Health departments are interested in these pro- 
duce gardens in that they occupy sites which 
might otherwise be breeding places for filth and 
disease. 



Vacant Lots or Gardens 131 

Every vacant lot is potentially a dumping 
ground and a source of insanitary condition in 
the neighborhood where it is located. It is very 
tempting for residents to throw their refuse, 
empty boxes, bottles, tin cans and waste paper on 
neighborhood lots. These accumulations soon 
act as receptacles for rain which during warm 
weather are fertile breeding places for mos- 
quitoes. 

Furthermore, vacant lots which are unkept 
harbor weeds which in the spring and autumn 
are distributors of the pollen largely responsible 
for hay-fever. Mention is also made of the un- 
sightliness of unused lots. The most feasible and 
practical way of ridding a city of these nuis- 
ances is to convert them into produce gardens. 

The Vacant Lot Association in Philadelphia 
has accomplished a double purpose by its plan 
of distributing grounds and lots for the cultiva- 
tion of table commodities. It furnishes healthy 
outdoor employment for the young and old and 
at the same time provides edibles to meet the 
family needs. What has been done by this or- 
ganization can be done privately at home in back 
yards and on unused lots. 

Much has been said about dirty and dusty 
streets. A large share of this nuisance originates 
in the empty lot and unclean back yards. By 



132 Fresh Air — A Germicide 

utilizing every foot of available ground for the 
growth of garden products, flowers, plants and 
vegetables, we not only reduce the source of many 
insanitary conditions in the city, but furnish that 
little tint of green which makes for a city beauti- 
ful and a city healthful. 



Fresh Air — A Germicide 

A MONG the various agents employed to com- 
bat the infectious winter diseases, there is 
none better than fresh air. Sanitarians have 
taken advantage of this fact by advocating the 
free ventilation of the home, bedroom, theatre, 
street car and other public assemblies. The gath- 
ering of large numbers of persons indoors quickly 
vitiates the atmosphere with emanations from the 
bodies rendering the air more or less foul and 
favoring the dissemination of infectious germs 
by coughing, sneezing or expectoration. Free 
access of fresh air not only dilutes the contam- 
inated atmosphere but actually destroys the active 
agents of disease. 

Fresh air is nature's best germicide. In the 
treatment of tuberculosis, it is the best tonic 
known to medical science. At the Philadelphia 



Fresh Air — ^A Germicide 133 

Hospital for Contagious Diseases, diphtheria 
cases do remarkably well when treated on the 
balconies in the open air. In fact all the infec- 
tious diseases make more speedy recoveries when 
patients are permitted to have a free circulation 
of air in the sick-room. 

Following the quarantine for the various 
communicable diseases, public health officials are 
now relying upon free ventilation of the sick-room 
as a measure of terminal disinfection in prefer- 
ence to the use of chemical disinfectants. More 
especially is this true in cases of the minor in- 
fectious diseases. 

During the winter months when the respira- 
tory infections are at their height, the subject of 
ventilation should be considered as essential in 
the prevention of disease. In the office, work- 
shop and factory adequate ventilation with free 
circulation of fresh air, renders the conditions 
healthier and more comfortable for the employes. 
Where fresh air is lacking, germs find fertile 
breeding places for growth and reproduction. 

Plants which are kept indoors during the 
winter do not thrive very well in overheated 
places lacking free circulation of fresh air. Per- 
sons living under similar conditions cannot be 
expected to be hale and hardy. More especially 
is this true of children and young adults. 



134 The Open Window Habit 

The very young and the aged are apt to 
stay within the home during the cold season and 
the approach of spring finds them pale, feeble 
looking, with an expression of sapped vitality. 
Old age and infancy do not require confinement 
to the constant indoor atmosphere during the 
winter months. On days when the weather is 
favorable, calm and pleasant, there is no better 
stimulus than the outside fresh air. 

The body itself is largely made up of oxygen 
and nitrogen which are essential constituents of 
air. To replenish the body with these vital ele- 
ments, it is necessary that every room used for 
human habitation be properly ventilated and that 
a reasonable part of the daily twenty-four hours 
be spent outdoors. 



The Open Window Habit 

\\T ITH the approach of cold weather there is a 
tendency on the part of many to close down 
the windows. Drafts and chills are indeed un- 
comfortable and prejudicial to good health, but 
these can be avoided if the ventilation of the office, 
living room, and bedroom is properly regulated. 
Fresh air is nature's best germicide and in order 



The Open Window Habit 135 

that it may be brought into use to its fullest 
extent, windows must be kept open or at least 
ventilators installed where healthful surround- 
ings are desired. 

More especially should the open window 
policy be carried out when the weather condi- 
tions are quite favorable. In office buildings, 
work rooms and in the schools it is advisable to 
thoroughly air the rooms during lunch hours or 
at a suitable period during the day by raising all 
the windows. By such procedure the stagnant 
atmosphere is thoroughly removed and the room 
filled with fresh, invigorating cold air. 

In overcrowded assemblies and workshops, it 
is very difficult to obtain satisfactory ventilation. 
In such instances there should be measures for a 
constant inlet of air and a constant outlet or 
exhaust. A free and continued circulation of 
fresh air is essential to maintain a clean whole- 
some atmosphere indoors. In the case of amuse- 
ment places, it is well to throw open the doors at 
the end of each performance in order to replace 
the foul air within. 

More especially are we concerned with the 
ventilation at home. Very often when passing 
through the residential section of the city on a 
cold night, the windows are seen closed tightly; 
although a certain amount of ventilation takes 



136 The Open Window Habit 

place between the shafts of the windows this is 
insufficient. The oxygen of the air is consumed 
by the occupants and the atmosphere adulterated 
by the exhaled breath. To secure the desired 
quantity of fresh air and oxygen, open the 
windows. 

When the weather is cold and severe the 
windows need not be thrown open to the top, but 
sufficiently lowered from the top and raised 
from the bottom to admit a constant supply of 
fresh air. The amount of raising and lowering 
of windows, is regulated of course by the clem- 
ency of the weather. 

The public should adopt the open window 
habit. The best way to avoid winter infections 
is by breathing fresh air. Pneumonia, tubercu- 
losis and colds are bad air diseases. The open 
window policy will go a long way toward reduc- 
ing their prevalence during the winter months. 

Overcrowding in street cars is a menace to 
the public health because it encourages conditions 
which are conducive to the spread of disease. 
Coughing and sneezing are not infrequent in 
street cars and these acts tend to inject infectious 
material into the atmosphere which is breathed 
over and over again by others, thus exposing them 
to such infections as tuberculosis, influenza, ton- 
silitis, coryza or, in fact, any infectious disease. 



Ventilate the Garage 137 

Although street cars are provided with means 
of ventilation, these are not always used to ad- 
vantage or properly supervised and frequently 
prove inadequate. Passengers are liable to raise 
or lower windows in the cars for their own com- 
fort, but very often to the disadvantage or dis- 
comfort of others present. A proper and effec- 
tive adjustment of the ventilation and the avoid- 
ance of overcrowding in street cars will greatly 
assist and thus protect the public from the possi- 
bility of the spread of disease. 



Ventilate the Garage 

T^HE attention of health officials has been 
called to a disease popularly named petro- 
mortis caused by the inhalation of exhaust fumes 
from gasoline engines. Gasoline poisoning or 
petrolitis is not a new disease but the publicity 
given to a number of deaths which have recently 
occurred from this cause has created the impres- 
sion that this condition might be a new one. The 
extensive use of gasoline due to the rapid prog- 
ress of the automobile has however increased 
the number of cases of gasoline poisoning and 
it is surprising that many more have not been 



138 Ventilate the Garage 

reported to the health authorities. It is very 
hkely that many persons have experienced the 
effects of exhaust fumes from gasohne engines 
but since these were only temporary, no com- 
plaints were made to warrant a thorough investi- 
gation. 

Poisoning by gasoline fumes was at one time 
a frequent occurrence among seamen on sub- 
marines when their power of locomotion de- 
pended upon gasoline. The men were often sub- 
ject to fainting spells and extreme weakness 
occasioned by the inhalation of partly consumed 
gases and it became necessary at times to transfer 
those affected to other duties. New inventions 
on the undersea craft has practically eliminated 
this condition among the seamen. This same 
condition, however, now confronts those who are 
constantly working about automobiles and gaso- 
line engines. Incomplete combustion of the gas 
allows noxious odors to fill the atmosphere which 
when inhaled give rise to headache, dizziness 
and if prolonged, even unconsciousness. This 
may occur more especially in small unventilated 
garages. When the engine of a machine is run- 
ning it consumes the oxygen of the air and if the 
combustion is incomplete the poisonous gases fill 
the air. It is, therefore, essential that every 
^workshop and garage have adequate means to 



The High Cost of Heating 139 

carry off the accumulated gases and to permit an 
adequate supply of fresh air. This should be 
especially considered when building repair shops 
and garages, particularly the portable kind. 

Persons employed in this capacity should 
insist on the safety-first plan of sufficient ventila- 
tion to insure against sickness or accidental death 
from this entirely preventable cause. 



The High Cost of Heating the 
Home 

TXT'HILE the authorities are making every 
effort to reduce the price of the most 
essential fuel product, housekeepers and janitors 
in our homes and apartment houses are wasting 
an unusual quantity of coal in the attempt to 
render the home and living quarters comfortable. 
On entering the average house during the cold 
season, one is immediately swept with a wave of 
hot, dry, stuffy, parched air which has been de- 
scribed by some writers as drier than the driest of 
deserts. Such a state of atmosphere is unfavor- 
able to good health and, at present when coal 
is a costly household commodity it is an extrava- 
gance to waste it by using it haphazardly without 



140 The High Cost of Heating 

securing the greatest amount of fuel value in an 
intelligent way. 

In order that the indoor atmosphere be com- 
fortable and healthful, a certain proportion of 
moisture must be present. When heat is admit- 
ted to the office or Hving room, there is a tendency 
for the moisture to evaporate. On very cold 
days, added fuel to the fire seems to scorch the 
air, depriving it of the normal amount of humid- 
ity, rendering it rather dry. This atmosphere 
soon becomes uncomfortable because it causes an 
increased evaporation from our bodies, irritates 
the nose and throat and by reason of its dryness 
leads to the usual catarrhal condition common 
during the winter season. 

The power of air to absorb and retain heat 
depends largely upon the amount of moisture or 
water vapor that it contains, and when indoor air 
lacks the proper amount of this moisture the 
temperature of the home or office must be main- 
tained at a higher degree, to give the same sensa- 
tion of warmth and comfort to our bodies, than 
is required with air containing a normal amount 
of moisture. 

The thermometer should therefore always be 
the guide in determining the amount of heat 
supplied. If a temperature of 68 to 70° Fahren- 
heit in a heated room is uncomfortable and 



The High Cost of Heating 141 

chilly, more than likely the atmosphere does 
not contain a sufficient amount of moisture and 
the dry air is causing rapid evaporation of the 
normal body sweat, producing a sensation of cold. 
If such is the case, it is cheaper and better to add 
moisture to atmosphere than it is to add coal to 
the furnace. This is accomplished by maintain- 
ing a proper system of ventilation in home. In 
fact, no heating system is efficient unless it is 
combined with a proper system of ventilation 
which adds moisture to the dried air, carries 
away the contaminated atmosphere, and supplies 
fresh, healthy outdoor air. 

The use of pans filled with water, and placed 
in the heated room and other such measures to 
supply the moisture have not proved sufficiently 
effective to produce the desired amount of com- 
fort and ease. Of the various methods of adding 
moisture to the heated air, proper and sufficient 
ventilation holds first place. The ideal indoor 
conditions favorable to good health are a tem- 
perature of about 70° Fahrenheit and a relative 
humidity of 65 per cent. 



Coal Gas Detrimental to Health 

ir\URING severe cold weather, when stoves, 
furnaces and other heating devices are 
taxed to the Hmit in order to keep out the unwel- 
come chill and cold from the home, office and 
workshop, we are confronted with the danger of 
vitiating the atmosphere with unconsumed or 
incompletely burned gases which may escape from 
defective heating systems. Coal gas is the poison 
which we must guard against and which may 
ultimately result in serious illness if constantly 
inhaled. Fatalities are occasionally recorded 
from poisoning by this gas either accidentally 
from coal ranges, from leaky gas pipes or by 
premeditated design. Cases are on record in 
which tramps were known to have been killed by 
gas from large furnaces or lime kilns to which 
they had been attracted by their warmth and 
where they had fallen asleep. 

When a mere trace of coal gas is present in 
the air we breathe, the poisonous effects upon the 
body are of course correspondingly mild, the 
degree of severity depending upon the degree of 
contamination of the air and the length of time 
that gas-poisoned air is inhaled. Obscure mental 
disturbances and even delirium may be the first 
prominent symptoms of poisoning. The usual 

(142) 



Coal Gas Detrimental to Health 143 

symptoms, however, of chronic poisoning from 
coal gas are headache, dizziness, sick stomach 
and even vomiting, throbbing of the temples, 
ringing in the ears, general lassitude and muscu- 
lar weakness. Neuralgia symptoms are often 
manifest while anemia or impoverishment of the 
blood is usually a resulting condition. 

Chronic poisoning from coal gas may occur 
in poorly ventilated living rooms, offices or work- 
shops where coal or gas is used as fuel for heat- 
ing purposes. It is generally some defect in the 
heating system which permits the escape of the 
poisonous gas. Where coal stoves, ranges or 
furnaces are used, it is usually a defective flue or 
poor draught or improperly regulated damper 
which are the sources of origin of the escape of 
gas into the room. It is therefore advisable that 
householders have defects of the heating appar- 
atus adjusted, in order to insure safety to the 
occupants of the home. 

Leaking gas fixtures are not only an expense 
because of waste of gas but are a serious menace 
to health. Gas jets should burn steadily without 
jumping and flaring; if they do not, they are 
allowing unburned gas to escape. Gas tubings, 
hot water heaters, gas lamps and other gas heat- 
ing apparatus should always be kept in good 
order and free from leaks. 



144 Clean Streets Essential 

If several persons in the same house are 
suffering from symptoms previously outlined, 
there should be an immediate inspection of all 
fuel consuming devices in the home for the source 
of coal-gas poisoning. 



Clean Streets Essential for a Clean 
Bill of Health 

nr^HE campaign for cleaner streets which is 
being conducted in all earnestness by all 
cities is a very important movement from the 
standpoint of public health. It has been recog- 
nized that street dust, especially in a large city, 
may be the distributing focus of dangerous 
disease germs, or at least so irritate the respira- 
tory passages as to lower their resistance and 
thus predispose the nose, throat and lungs to 
infection. Fortunately, the natural elements, 
more particularly sunlight, kill many of the 
''flying" disease breeders before they are inhaled. 
Some few, however, maintain their vitality, and 
lodging in the eyes, ^ive rise to various inflam- 
matory conditions, or finding lodgment in the 
respiratory passages may cause serious damage, 



Clean Streets Essential 145 

The nuisance created by street dust can be 
largely abated by sprinkling and flushing the 
streets but these methods prove to be of only 
temporary value if rubbish, waste and house 
sweepings are permitted to be scattered by the 
winds from uncovered receptacles immediately 
after the streets are cleaned. Carelessness on 
the part of storekeepers and housekeepers is 
responsible for many of these nuisances which 
give the appearance of untidiness and uncleanli- 
ness on some of the highways. 

Personal pride should command every house- 
holder to prevent or abate any disorder and un- 
tidiness on the street where he lives for its neat- 
ness generally gives an air of freshness, dignity 
and refinement to the dwellings facing it. Local 
business organizations can also do much toward 
urging the residents of their respective neighbor- 
hoods to co-operate with this plan to make our 
highways "spotless.'' 

This display of cleanliness is not intended to 
be a temporary one, but should be continued 
throughout the year as an essential movement 
toward better sanitation and better health. The 
following is a sample resolution which might 
effectively be adopted by every board of health. 

Resolved, That the Board of Health approves 
the following receptacles and methods of handling 

10 



146 Eliminating the Dust Nuisance 

garbage, ashes, rubbish, waste paper, and Hke 
refuse : 

All receptacles for garbage shall be of metal, 
tightly made, and shall be covered with close- 
fitting covers. 

Receptacles for ashes shall be substantial, 
tight containers, preferably of metal, and should 
not have a capacity of over five cubic feet; and 
they should not be filled higher than three inches 
from the top of the receptacles. 

Rubbish, waste paper, and like refuse shall 
be securely bundled or placed in tight receptacles 
in such manner as to prevent them from causing 
a nuisance upon the property or upon the street, 
and ''contractors or others removing refuse or 
other waste shall so handle it as to prevent it 
from escaping or becoming a nuisance on or to 
other properties or the public street.'' 



Eliminating the Dust Nuisance 

"LJ EALTH officials fully appreciate the fact 
that the generation of dust in large cities 
with the many industries and extensive highway 
traffic is inevitable. In spite of the various 
sources of dust there are means within our reach 
which could reduce this nuisance to a minimum, 



Eliminating the Dust Nuisance 147 

at least to such an extent as to eliminate it as a 
serious menace to the public health. 

Street dust can largely be controlled by daily 
flushing. The public officials in spite of the low 
water pressure have carried out this part of the 
health programme. There remains, however, the 
public sidewalks which must be kept clean and 
free from dust. Every householder and store- 
keeper is both morally and legally obligated to 
keep the walk in front of the house or store free 
from papers, rubbish, ashes, dirt or other refuse. 
Dry sweeping is absolutely forbidden. Sweep- 
ing the dust into the windows of neighbors and 
saturating the air with germs of disease, requir- 
ing passersby to hold the breath and blink the 
eyes, is an imposition upon the rights of others. 
The health menace of dry sweeping needs no 
explanation. 

Furthermore the public can help to reduce the 
dust nuisance by depositing their house sweep- 
ings, dirt and refuse in receptacles of suitable 
structure as to avoid leakage, and in such 
amounts as to prevent spilling on the pavements 
and streets. The health laws should make this 
precaution mandatory. If every housekeeper 
abided by this ruling faithfully, there would be 
no need for placing a threatening club in the 
hands of every police officer. 



148 Safety on the Streets 

The careless public must learn to be more 
careful. Persons in the habit of throwing things 
into the street, must be broken of the habit. 
Promiscuous spitters must use their handker- 
chiefs. 



Safety on the Streets 

U ACH year there are several hundred deaths 
from moving vehicles in each of the larger 
cities, a death toll greater than that of typhoid 
fever and scarlet fever combined. Although this 
subject is not strictly a health matter, neverthe- 
less, anything which increases the death rate in 
any community is of interest to the Department 
of Health. Opportunity is, therefore, taken to 
warn pedestrians and drivers of vehicles against 
the danger of accidents. While many fatalities 
are due to reckless driving, by far the greater 
number are due to carelessness and thoughtless- 
ness on the part of pedestrians when crossing the 
streets. Moving vehicles should always be given 
the right of way, but not infrequently we see per- 
sons run directly in their path. 

The warning cannot be made too strenuously 
against the foolish practice of running in front of 
street cars after alighting, as there is always 



Safety on the Streets 149 

danger from some vehicle approaching in the 
opposite direction. 

Children are frequent victims of accidents by 
moving vehicles. It is, therefore, the duty of 
parents to forbid them to play in the streets and 
to caution them against the dangerous practice 
of catching on behind street cars, auto trucks, 
ice wagons or of holding on to moving vehicles 
while skating or cycling. They should be taught 
not to cross the street in the middle of the block 
but only at the regular street crossings. Cities 
might well adopt "playstreets" where traffic is 
suspended and where children might play to their 
hearts' content, especially in districts where play- 
grounds are not provided. 

It seems reasonable also that drivers of motor 
vehicles should be required to pass a suitable 
physical examination with particular reference 
to their vision and hearing. A technical exam- 
ination to determine their proficiency in running 
a motor driven vehicle is also in order. This 
should also apply to motorcyclists who, by their 
reckless and daring coasting between and about 
other moving vehicles, are responsible for many 
avoidable accidents. New Jersey has already 
adopted the plan of physical and technical ex- 
amination of drivers of motor driven vehicles to 
safeguard the public from accidents. 



150 Safety on the Streets 

Drivers will avoid many accidents by lessen- 
ing the speed at all street crossings. They should 
abolish the practice of crossing the path of ap- 
proaching street cars or of speeding past the 
automobile just ahead. Furthermore, the over- 
turning of automobiles will be less frequent if 
competent drivers are at the wheels. 

Particular caution should be exercised at rail- 
way crossings, where accidents often result from 
carelessness or failure on the part of drivers to 
heed warning gongs and whistles. 

The following is a list of rules adopted by the 
Safety-First League of Philadelphia, concerning 
children especially: — 

1. Always go to the main street crossing 
before you cross the street. 

2. Before crossing the street — stop! Look 
in both directions. 

3. When crossing in back of vehicles — look ! 
See what is coming the other way. 

4. Trolley bells and motor horns mean dan- 
ger. LISTEN ! for them. 

5. Always find a safe place for play — the 
streets are never safe. 

6. Keep off the back of moving vehicles. 

7. Teacfi the younger children the Safety- 
First way. 



Occupation and Disease 

TT has long been recognized that the health of 
persons engaged in certain occupations may 
at some time or other become directly or in- 
directly affected as the result of such vocation. 
Persons who work in extremes of heat or are 
constantly exposed to the influence of poisonous 
gases or irritating dusts may suffer such physical 
injury as to predispose them to disease or to 
cause more or less permanent debility. Thus 
tuberculosis, anthrax, metallic poisoning, skin 
disease, impaired vision and a host of other 
defects may result from lack of proper sanitary 
supervision in work shops. The subject of occu- 
pational diseases is, therefore, an important one 
as a public health problem and deserves consid- 
eration, not only by the health officials but by 
employers of labor. 

The enforcement of the Workmen's Compen- 
sation Act, provides financial aid for the worker 
injured in the course of his employment, but the 
person who develops any chronic ailment as the 
result of his vocation, must sustain the loss incur- 
red thereby, while his dependents must seek other 
means of support. It is hoped that in the near 

(151) 



152 Occupation and Disease 

future, occupational disease may also be classi- 
fied as an injury and receive like consideration 
for compensation. In the meanwhile, employers 
should use every means to safeguard the health 
of workers. Preventive devices and improved 
machinery will materially reduce the quantity of 
dust and aid materially in lessening the contam- 
ination of the atmosphere. Certain dusty opera- 
tions could be conveniently confined in hoods or 
in especially constructed cabinets in order to con- 
fine the dust and to protect the workers nearby. 
If these means cannot be adopted, the number of 
persons exposed should be reduced to a minimum. 

Where poisonous gases and fumes are used, 
employes should be particularly protected from 
their harmful influence. Among the various sub- 
stances which may affect workers are arsenic, 
benzine, benzol, carbon bisulphide, brass, carbon 
monoxide, compressed air, dinitrobenzine, mer- 
cury, naphtha, natural gas, phosphorus, turpen- 
tine and wood alcohol. 

A profitable lesson may be learned from some 
of the large industrial plants which have already 
made a minute study of the protection of em- 
ployes, and have gone so far as to furnish rest 
rooms, reading rooms, gymnasiums and athletic 
fields for their use during spare moments. 



Prevention of Industrial Accidents 

/^ VER one quarter of a million accidents 
occur in Pennsylvania every year, lo per 
cent, of which are fatal, while a large propor- 
tion result in total incapacity or partial disability. 

The Department of Labor and Industry of 
Pennsylvania reports yearly over 20,000 acci- 
dents to the eyes, of which nearly 350 have 
resulted in total blindness. It is believed that 
this number, however, is far below the actual 
number of cases since many injuries to the eyes 
are not recorded. In one hospital in Philadelphia 
over 4000 eye injuries are treated annually. If 
this number is used as a basis for computing the 
total injuries in all the hospitals treating acci- 
dents to the eyes, it is self evident that the State 
figures will be greatly increased. 

The important point which we desire to em- 
phasize is that a large proportion of these acci- 
dents are preventable. Both life and limb can 
be saved by exercising a little care, good judg- 
ment and discretion when engaged in industries 
where accidents are likely to happen. The loss 
of nearly $8,000,000 in wages and over 3,000,000 
working days every year in this State may be 
counted in the waste of industry which could 
largely be avoided. 

(153) 



154 Prevention of Industrial Accidents 

Employers have learned the advantages of 
providing safety devices on machinery and of 
instituting educational campaigns, warning the 
men against the dangers of carelessness which 
may lead to more or less serious accidents. 

Of great importance is the protection of the 
eyes against injuries. Trivial accidents to the 
organs of sight may result in total blindness 
or in serious impairment of vision. Such occu- 
pations as chopping, grinding and blasting, rivet- 
ing, working under intense light and heat or with 
molten metal and acids predisposes to injuries 
which may prove very serious. The proper ad- 
justment of goggles and their constant use is, 
therefore, essential in such industries. Mush- 
roomed tools* are also the source of injuries to 
the eye sight which are entirely avoidable. Tools 
of this kind should be tabooed among employes. 

Under the Workmen's Compensation Act, 
employers are responsible for injuries to em- 
ployes but such compensation does not really pay 
for the suffering and pain endured or for the in- 
validity which deprives the individual of competi- 
tion with his fellow men. 



* Mushroomed tools are those with heads which are spread 
out as the result of constant hammering. The head of a ham- 
mer may be mushroomed by frequent use, in which case the 
overhanging edges may be easily broken off as chips. 



Foot Strain and its Relation to 
Health 

nr^HERE is probably no other complaint so 
universal and so generally talked about 
as sore feet. This disease has its origin with 
the adoption of the custom of wearing shoes 
which through ages have changed in shape, man- 
ner of manufacture and in style and have accord- 
ingly caused more or less irregularities of the 
feet. Not only is this a problem among civilians 
but also among the military ranks where foot 
troubles form a, large percentage of the physical 
surveys from service. 

Tired, aching, burning and painful feet are 
very often the cause of a general systemic de- 
pression of vitality. Occupations requiring one 
to stand on the feet constantly and for a great 
length of time are responsible for a large pro- 
portion of these complaints, and ill-fitting foot- 
wear exaggerates the tendency toward foot 
troubles. 

It is commonly believed that all painful feet 
are the result of fallen arches. This is by no 
means true because many flat feet are not painful 
and many painful feet are quite normal in shape. 
Tight shoes have their detrimental effects but are 
often unjustly blamed for other defects. 

(155) 



156 Foot Strain and Health 

The heel of the shoe plays an important part 
in the maintenance of the normal contour of the 
foot. Its original purpose was to keep the back 
part of the shoe out of the mud, but now grade, 
form and style seem to be its function. When 
the heel reaches such a height that the weight 
of the body is supported by other than the normal 
parts of the foot, then we are confronted with a 
multitude of complaints from sore feet. 

Proper shoes are therefore essential for the 
proper function of the feet. To designate any 
particular shape, quality or make of shoe would 
be folly, for every foot requires its individual 
shoe. All that can be recommended is that such 
shoes should be selected which give the greatest 
amount of comfort and ease. 

More especially is the subject of proper foot- 
wear essential to the business woman who is 
required to stand during the greater part of the 
working period. Complaints peculiar to her sex 
may have their origin from malposition of the 
pelvis caused by shoes which tend to throw the 
weight of the body forward. The general tired 
feeling often complained of by the shop girls at 
the end of the day's work may be attributed to 
foot-strain from poorly fitted shoes. 

The remedy rests principally in the proper 
selection of shoes and in taking advantage of the 



Underweight and its Significance 157 

rest periods during working hours by sitting 
down. When complaints are continued in spite 
of these precautions, it is best to consult your 
family physician who will advise you as to the 
proper course to pursue. 



Underweight and its Significance 

nr^HE body weight is the barometer of one's 
physical state of health. Excessive avoir- 
dupois and underweight are both abnormal 
conditions which call for appropriate medical 
attention according to the individual case. The 
military authorities of all nations recognize the 
fact that persons who fail to meet the standard 
weight according to their age and height are 
unsuitable for a service which requires the high- 
est type of physical qualifications. 

Underweight is indicative of many abnormal 
factors. It may be a precursor of tuberculosis or 
a predominating symptom of cancer. It may 
point to some derangement of the digestive tract 
which interferes with the proper assimilation of 
food or it may be due to an unstable nervous 
system which indirectly influences the physical 
development. Irregular habits of living, ex- 



158 Underweight and its Significance 

cesses, improper housing and unsanitary indus- 
trial conditions are all intimately related to the 
overbalance of physical equilibrium resulting in 
loss of weight. 

Every person whose weight is below normal 
should consult the family physician with the view 
of ascertaining the cause and manner of correct- 
ing this deficiency. There are many cases of 
underweight which are unattended with any 
visible or detectable physical disease. These are 
the cases which under properly regulated routine 
measures, respond to treatment. A change of 
environment, together with the administration of 
wholesome foods, very often bring about a rapid 
increase in the body weight. As an instance of 
this, we may cite the experience of our boys in 
military training, who invariably gain in weight 
during the first few months of service. The 
regulation of habits — early to bed and early to 
rise — good, wholesome, fresh and nourishing 
foods selected under expert supervision and the 
adequate medical attention given to the recruits, 
tend to cause a change in their physical conditions 
which are favorable to good health and good 
physique. 

The discipline of military life, the setting up 
exercises and the carefully regulated routine 
manner of living which are planned in detail and 



Cancer a Curable Disease 159 

carried out by experienced officers, all tend to 
bring about an improved physical state. It would 
certainly benefit many persons who are under- 
weight to receive similar training. 

Outdoor exercise, living in well ventilated 
homes, attention to personal hygiene, regulation 
of habits and the selection of proper foods are 
quite essential for those whose weight is below 
par. A progressive and continued decrease of 
weight is indicative of serious disease, for which 
medical attention is desired at once, for delay 
may help the disease to make advances too late 
for correction. 



Cancer a Curable Disease 

TJf EALTH authorities throughout the country 
have joined forces to combat the increasing 
prevalence and death rate from cancer. This 
disease alone causes 80,000 deaths in the United 
States each year. If this loss 'of life is repeated 
during the present year, one out of every eight 
deaths among women over the age of 40 and one 
out of every fourteen deaths among men of the 
same age will be due to cancer. These facts are 
surely sufficient evidence to show that this sub- 



160 Cancer a Curable Disease 

ject is not a trivial one but is of utmost import- 
ance to the individual, to the city, the state and 
the country at large. 

The first and foremost fact which the public 
should know and remember is that cancer is cur- 
able. The old idea that this disease meant posi- 
tive death no longer holds true in the light of ad- 
vanced medical science ; nor is it true that cancer 
is catching or contagious as some of the old folks 
would have us believe. Furthermore there should 
be no fear of inheriting this disease as the theory 
of heredity has not been conclusively shown. 
These assurances, therefore, place an entirely 
hopeful aspect upon the subject of cancer. 

Although we do not know the actual cause of 
cancer we certainly know much about it. We 
know that the disease begins as a small growth 
such as a wart, mole, lump, scab or ulcer which 
is slow to heal. These may appear as innocent 
growths at first but repeated injury or constant 
irritation may cause them to take up an unusual 
activity especially in persons over 40 years of 
age. Jagged teeth may be the exciting cause of 
ulcers of the tongue ultimately resulting in can- 
cer, while pipe smoking and cigar smoking may 
so irritate the lips that carcinomatous ulceration 
may result. Persons of middle age who suffer 
constantly from stomach disorders should regard 



Cancer a Curable Disease 161 

their symptoms with suspicion, as this organ is 
the most frequent site of cancer. Women, partic- 
ularly, should consider every lump or growth on 
the breast as potentially malignant and seek the 
advice of the family physician at once. 

It should also be known that there is but one 
positive cure for cancer, which is early and com- 
plete removal. Surgical treatment gives the best 
results provided it is done at the onset of the 
disease. Plasters and salves give only temporary 
relief. The patient is given a false sense of hope 
while the disease is actually taking deeper root. 
Internal medicines are worthless and a waste of 
time and money. Radium therapy, however, is 
valuable when used for superficial cancers of the 
skin, mucous membrane and certain tumors of the 
bone which are not very malignant, and only then 
when used by experienced physicians. The 
X-ray is a great aid in making the diagnosis of 
internal cancer and may be of benefit after sur- 
gical operation when a small portion of the tumor 
has been left behind. Fulguration, which is the 
process of destroying superficial growths by an 
electric spark is beneficial in selected cases and 
under expert handling. 

The secret of the successful cure of cancer is 

to consult your family physician at the first sign 

of an unusual growth or lump upon the body. 

11 



162 Sleep Essential to Good Health 

Delay greatly reduces the chances of recovery 
while prompt treatment may prevent an avoidable 
death. 



Sleep Essential to Good Health 

T F it were possible to enact an eight hour sleep- 
ing law to balance the labor law of similar 
title, there would undoubtedly be a great improve- 
ment in the health, well-being and efficiency of 
the community. Cheating the body of its natural 
period of rest and comfort to procure a little more 
entertainment in the wee hours of the morning 
is like driving a machine on a flat tire. It is 
absolutely impossible to maintain a good state of 
health if late hours are kept night after night, 
because the vital forces necessary to combat dis- 
ease are reduced below par and the invading 
germs find a fertile soil for their development. 

Sleep is a part of the daily necessities of life. 
It is the restorer and regenerator of physical and 
mental strength. Just as the lull in battle is the 
time apportioned to the clearance of waste and 
the advance of new troops for a fresh and re- 
newed onslaught, so sleep permits the elimination 
of fatigue products and the reaccumulation of 
energy for the next day's work. 



Sleep Essential to Good Health 163 

The greater part of the infant's hfe is spent 
in sleep, during wjiich time the constructive 
forces are at work building up the tissues of the 
body and the process of development exceeds the 
destructive changes. In the adult, however, con- 
struction and destruction balance each other and 
any tendency to increase the latter over the 
former results in a reduction of bodily strength. 
It is, therefore, essential that every adult sleep at 
least eight hours each day in order to preserve 
his state of health. 

People of neurotic tendency who are troubled 
with insomnia may be greatly improved by taking 
an occasional day off from their regular routine 
work and resting up in bed, thus permitting the 
elimination of the products of fatigue and nerve 
tire. The use of hypnotic drugs to induce sleep is 
severely condemned because of their habit form- 
ing nature; furthermore the sleep produced by 
them is unnatural and less effective than normal 
sleep. 

The tired, worn out laborer finds little trouble 
in falling to sleep at night, while the mental 
worker may have great difficulty in securing the 
needed rest. This is explained by the fact that 
physical work is essential to bring about the 
desired effect of sleep. The office worker and the 
busy merchant will therefore find that systematic, 



164 Sleep Essential to Good Health 

daily exercise may be of great help in warding off 
insomnia. 

The normal healthy person does not complain 
of great effort to rise in the morning, nor does 
he present a haggard tired look with bloodshot 
eyes and pale countenance. His appearance is 
fresh and bright, the day is started with an air 
of happiness and good cheer. He has a kind 
word for his friends and the day's labor goes 
on without any mishap. Just contrast this with 
the man who keeps late hours at night; he 
is aroused from his sleep with difficulty, eats but 
a scanty breakfast or none at all and is usually 
late at the office. He is irritable, peeved and 
cannot concentrate upon his work. The day is 
long and tiresome and nothing is accomplished 
satisfactorily. 

We all recognize the importance of sufficient 
sleep, but it is not until the evil effects' of inade- 
quate rest become evident that effort is made to 
adjust the deficiency. Offenders of the eight 
hour sleeping law should therefore try to make 
up the sleep lost through careless habits. There 
is no greater remedy than the rest which sleep 
brings. It is a healer of all physical and mental 
troubles and is the physician's best remedy in the 
treatment of disease. If every member of each 
household would abide by the eight hour sleeping 



Proper Winter Clothing 165 

law, there would be less sickness, more happiness, 
more glad 'Tollyannas" while efficiency and well- 
being would prevail. 



Proper Winter Clothing and its 
Health Aspects 

TN attempting to keep out the cold and confine 
the body heat to insure comfort and ease, we 
often overburden ourselves with clothes. It is 
not so much the quantity as the quality of mate- 
rials used in the make-up of our garments which 
goes far to protect and preserve the normal func- 
tion of the skin. Excessive and heavy weighted 
clothes not only cause a feeling of discomfort but 
predispose the body to the detrimental influences 
of sudden changes of temperature indoors and 
outdoors resulting in the common winter com- 
plaints of coughs, colds and pneumonia. 

The skin is much more sensitive to heat and 
cold than readily believed, being abundantly sup- 
plied with bloodvessels which are under control 
of an intricate nervous mechanism called the 
vasomotor system. This nerve supply increases 
the flow of blood to the skin under the influence 
of heat by dilating the bloodvessels supplying it. 



166 Proper Winter Clothing 

Cold, however, causes a contraction of the blood- 
vessels through this same vasomotor system and 
sends the blood to the deeper structure and in- 
ternal organs. In this way the human tempera- 
ture is regulated and the body protected from 
cold and excessive heat. Any interference with 
this heat regulating system may lead to delete- 
rious effects upon the body. For this reason, it is 
desirable that the skin be protected by proper and 
sufficient clothing to preserve the normal func- 
tional activity of the skin. 

The kind of material for underclothes has 
been the subject of much discussion from the 
standpoint of their relative merits to protect the 
body from cold and at the same time to permit the 
skin to carry on its respiratory function and that 
of eliminating the poisonous products of waste. 
Woolens, cotton, linen and silk all have their 
advantages and disadvantages and each may 
serve their purposes in the commercial field in the 
manufacture of clothes. Wool and cotton how- 
ever are the most practical materials which are 
within reach of us all so far as value and useful- 
ness are concerned. Wool readily absorbs the 
sweat of the body and permits a slow evapora- 
tion, preventing a rapid chilling of the body. 
Cotton, however, does not absorb as readily as 
wool, and moreover permits rapid evaporation 



Proper Winter Clothing 167 

causing an uncomfortable chilly sensation. All- 
wool underclothes are not serviceable because of 
shrinkage after washing. A combination of wool 
and cotton therefore is best suited from a health 
standpoint and for practical use. Close fitting 
garments of loose texture impart a pleasing sense 
of warmth and at the same time permit the proper 
exchange of air which is so essential in main- 
taining the respiratory function of the skin. 

Outer garments should be selected depending 
upon the kind of employment. Those engaged 
outdoors will of necessity choose clothing which 
will confine the body heat. Such clothes, how- 
ever, need not be heavy or of tightly woven tex- 
ture because the desired comfort can be obtained 
from light weight, loosely woven woolen outer 
garments. Those employed indoors should choose 
the lighter weight clothes to insure comfort and 
ease. 

If more attention were paid to the kind of 
clothes, with style as a secondary consideration, 
it is likely that many of the respiratory diseases 
of winter would be prevented. 



Stop That Noise! 

^^JUMEROUS and repeated complaints are 
charged against disturbing noises in the 
evenings, more especially during sleeping hours. 
Such protests against unnecessary and prevent- 
able noises have always received the endorsement 
of health departments, since the abatement of 
these nuisances is essential to preserve the com- 
fort and health of the residents of the community. 

Persons who are nervous or who suffer from 
insomnia or neurasthenia are particularly affected 
by-disturbing noises tending to reduce their state 
of health, while persons recovering from an ill- 
ness may be made worse or their convalescence 
prolonged. Hospitals and schools are generally 
protected against noises caused by pedestrians, 
venders, street musicians or fast driving vehicles 
by laws prohibiting such nuisances. 

Noises in the early morning hours by milk- 
men, bakers and garbage collectors are a source 
of great annoyance in the residential districts. 
Guests of hotels and apartment houses in the 
central section of cities complain that their sleep 
is disturbed by noises from automobile cutouts, 
loud blowing of horns and the loud crying 
of newspapers by newsboys. The annoyance 
should and can be stopped. The police in some 

(168) 



Stop That Noise 169 



cities are instructed to warn all offenders and to 
arrest them if they persist. The loud klaxon 
horn should be used only as a warning of ap- 
proach of a moving vehicle and not as a signal to 
the owner of a car that the chauffeur is ready 
for him or to attract someone's attention on the 
sidewalk or in a passing machine. The loud noise 
of the engine of a car which is at a standstill, 
and the odor of gasoline have been subjects of 
frequent complaint. 

Neighborhood quarrels over the barking of 
dogs and the crowing of fowls result frequently 
in an appeal to the courts to abate such nuisances. 
The shouting of the ice man in the back alley on 
a Sunday morning when many people prefer to 
sleep later than on other days is a very unwelcome 
noise. 

While no objection is made against the noise 
of horns, bells, sirens and whistles when used as 
danger signals by ambulances, patrols and fire 
engines, there is much objection to the unneces- 
sary use of these alarms by the same vehicles 
when on unimportant duty. This also applies to 
the objectionable noises of whistles on the river 
craft. 

We should further remember that there are 
thousands of night workers in every city, who 
must sleep during the daytime and, therefore. 



1^0 Sanitary Barber Shops 

deserve equal consideration. Of course, it is not 
possible to secure the calm and quiet of the 
country in large industrial cities, but every citizen 
has the right to complain when his personal 
rights are infringed upon and his sleep disturbed 
by the ceaseless clang of unnecessary noises. 



Sanitary Barber Shops 

TT is well recognized that the unclean barber 
shop may be the source of barber's itch, head 
lice, erysipelas, infections of the eye and various 
skin diseases. The adoption of legislation which 
aims to eliminate this source of infection is surely 
in order and should be earnestly encouraged. 

The public has learned the importance of per- 
sonal hygiene and is now demanding that every 
possible sanitary measure be adopted for the 
preservation and promotion of the public health. 
Barbers desiring favored patronage should, there- 
fore, aim to conduct their shops in a clean and 
orderly manner and should always maintain a 
high standard of efficiency in their sanitary 
management. As a guide to barbers who desire 
to lead this movement for cleaner and better 
service, the following rules are advocated for 
adoption : 



Sanitary Barber Shops 171 

Barbers should have good personal habits, 
keep their persons clean at all times and their 
breath free from odor. The hands should be 
washed after each patron. 

Barbers suffering from a communicable dis- 
ease should not be employed. 

A clean towel must be used for each patron, 
and should be laundered after each individual 
use. 

Patrons should be encouraged to furnish their 
own shaving mugs and brushes. 

Common shaving cups and brushes should be 
thoroughly cleansed after each use. The use of 
shaving powder in the shops would eliminate the 
common mug. 

Hair brushes and combs should be cleansed 
after each use and then placed in a formaldehyde 
sterilizer which should be provided in every shop. 

Razors, shears, scissors, clippers and tweezers 
should be sterilized after each use by immersion 
in boiling water. 

Powder puffs, sponges and finger bowls should 
be barred and the individual towel used in their 
stead. 

Electric massage brushes should be sterilized 
after each use. 

The common cosmetic stick should be tabooed. 



172 Sanitary barber Shops 

Bleeding can be stopped by dipping a cotton 
tipped tooth pick in a solution of adrenalin 
chloride or iron styptic. Alum should only be 
used in powder form. 

Soiled towels and shaving paper should be 
deposited in closed receptacles. 

Head rests of chairs should be provided with 
a clean piece of tissue paper after each patron; 
this can readily be accomplished by the adjust- 
ment of a suitable paper roll 

The wash bowl should be kept scrupulously 
clean. 

Patrons with skin diseases or visible erup- 
tions should either be refused service or the tools 
thoroughly disinfected after use. 

Barbers are cautioned against misbranding 
their tonics or refilling old bottles with substi- 
tutes. 

In the choice of barber shops the public should 
be guided by general observation of the place. 
By shunning the ill kept shop, you will encourage 
barbers to adopt the measures as advocated and. 
thus insure your own protection from avoidable 
infections. 



Sanitation of Swimming Pools 

* I ^HE popularity of the indoor swimming pool 
has created a demand for protection from 
infectious diseases which may be contracted in 
poorly supervised bathing houses. Investigation 
of the swimming pools in some of the larger 
universities shows that infectious colds, typhoid 
fever, diarrhea, skin diseases, and infections of 
the ear and eyes may occur when proper sanitary 
measures are not provided. 

A large number of bathers in one pool will 
certainly contaminate the water with the waste 
of the body. The degree of contamination will 
depend, of course, upon the freshness of the 
water supply and the number of bathers. If the 
water is permitted to be used repeatedly without 
clarification, filtration or dilution by a fresh 
supply, the danger of carrying infection to the 
bathers becomes apparent. 

Only a few years ago, there appeared a large 
number of patients at a hospital in Philadelphia 
for treatment of eye infections, contracted at a 
prominent swimming pool. Immediate measures 
of control were necessary to curtail this epidemic. 
Not infrequently we encounter colds among 
bathers who have contracted their infections at a 
public or private swimming pool. Every effort 

(173) 



174 Sanitation of Swimming Pools 

should, therefore, be made by managers of these 
bathing places to ascertain the sanitary condition 
of the pools for the protection of the public. 

Many places require a shower bath to be 
taken, accompanied by a soap rub before entering 
the pool. This will remove the superficial skin 
excretions and lessen the contamination of water. 

Others require a careful physical inspection 
of bathers to detect any visible communicable 
disease. 

During the summer months, when swimming 
pools are generally crowded, the water becomes 
clouded very rapidly. The addition of an effec- 
tive chemical disinfectant, such as chloride of 
lime, therefore, becomes necessary to reduce the 
turbidity and to render the water comparatively 
free from infectious germs. If the pools were 
also emptied, cleaned and refilled every day, the 
chances of infection would practically be elim- 
inated; but, owing to the expense attached to 
refilling spacious tanks, some method of filtration 
or chemical disinfection is necessary. 

Bathers should be especially cautioned about 
expectoration into the pool. The danger of such 
a practice becomes readily apparent. It often be- 
comes necessary for bathers to expectorate when 
water is taken in the mouth. For this purpose, 
a trough should be provided, surrounding the 



Home Sanitation " 175 



pool into which the bathers may spit and which 
may also be used to catch the wash water from 
the floor about the pool. No effort should be 
lost in adopting every measure to safeguard the 
public health by keeping the swimming pools 
clean and free from contamination. 



Home Sanitation 

A LL efforts to improve the health of persons 
by attention to personal hygiene will be of 
no avail if such persons return to live in homes 
which are insanitary. 

The following may be considered adequate 
requirements for proper sanitation of the home: 

Every home should have an adequate water 
supply to meet its needs for cleaning and bathing 
purposes. 

The plumbing in the house should be in good 
condition at all times. Leaking pipes should be 
repaired immediately. Dampness of the cellar 
may be due to leaks hidden in dark corners 
covered by discarded refuse. 

Drainage pipes should be free from obstruc- 
tions. Never throw sticks, stones, rags, pencils, 
brushes or other materials into the hopper, or 



176 Home Sanitation 

bath tub. These readily clog the pipes and give 
rise to insanitary nuisances. 

Special attention should be paid to the kitchen 
sink. All wash waters should be strained before 
thrown into the sink, or solid particles picked out 
of the wash water before pouring. All pipes 
should be open and not hidden from view. Closets 
under sinks are frequently infested with vermin. 
The open way permits absolute cleanliness. 

The cellar should be kept free from rubbish. 
All waste material should be discarded frequently 
and not allowed to accumulate. Wherever there 
is much refuse, rats, mice and vermin are sure 
to be found. 

Don't forget the back yard. The garbage 
pail should be metal, water tight, and should 
always be covered. Ash receptacles should be 
made of material which is firm and will not 
permit the contents to fall out. Never overload 
the ash box. Waste paper and other rubbish 
should be properly bundled. 

There should be plenty of room space for 
sleeping quarters. No more than two persons 
should occupy a bedroom ten feet wide, ten feet 
long and ten feet high. The window space should 
be at least one quarter of the floor space. It is 
a healthy habit to keep the bedroom windows open 
during sleeping hours. The windows may be 



Home Sanitation 177 



opened from the top and from the bottom, the 
amount of such opening depending on the 
weather. When it is very cold outdoors the win- 
dows can be raised and lowered only slightly but 
as the weather gets milder they should be opened 
fairly wide. 

The kitchen or dining room should never be 
used as a bedroom, nor any other room which is 
not provided with sufficient window space for 
ventilation. 

The bathroom should always be kept in a 
clean and orderly manner. 

The roof of the house should be kept free 
from leaks. Immediate repairs are necessary 
when leaks occur. 

In districts where the toilet facilities are out- 
side the house, the water closets should be al- 
ways kept clean and screened in the summer 
against flies. 

In selecting your home always choose one 
which receives a maximum of sunshine and has 
plenty of window space. Dark alleys and courts 
should be avoided. 



Disinfectants 

A LL kinds of ''so-called" disinfectants are on 
the market. The only kind of disinfectants 
which are valuable from the standpoint of the 
public health official are cleanliness, soap and 
water, fresh air and sunshine. A false impres- 
sion has long existed that certain chemicals can 
kill the germs of disease and thus prevent the 
spread of infection. The only instance where this 
is true is the disinfection of all the body dis- 
charges from a patient ill with a communicable 
disease. This means the discharges from the 
nose, throat and lungs, from the kidneys and the 
bowels, and sometimes the sweat. 

By disinfectants is implied agents, usually 
chemicals, used to kill disease germs. The term 
is further used in the sense of destroying organ- 
isms believed to exist in rooms, houses and build- 
ings where there has been a communicable dis- 
ease, or where conditions are such as to predis- 
pose to or favor the develjpment of an infectious 
disease. 

The common disinfectants are formaldehyde 
and sulphur. Various other chemicals classed in 
the trade as disinfectants are really antiseptics 
which are substances used to prevent the growth 
or inhibit the development of germs. Formalde- 
(178) :. 



Disinfectants 179 



liyde gas disinfection is still used by many health 
departments in homes following the severe con- 
tagious diseases as smallpox, scarlet fever, 
diphtheria, infantile paralysis, epidemic menin- 
gitis and others. 

Burning sulphur is a good disinfectant in 
homes infested with rats, roaches and other 
vermin. 

But these substances are gradually giving 
way to the simpler forms of disinfection which 
consist of complete cleanliness, washing down 
floors and wood work with hot water and soap 
suds and using the scrubbing brush vigorously. 
When carried out in addition to raising the 
windows for complete ventilation for a period of 
24 hours and exposing all the contents of the 
room or house to the open air and sunlight, we 
may feel safe that good disinfection has taken 
place. In order to be still safer, a complete 
renovation of the sick-room, with a change of 
wall paper is all that can be desired in effective 
disinfection. 

The use of chemical solutions in hoppers, in 
bathrooms, in garbage pails and in the kitchen 
sink give a false sense of security and are not 
necessary. Perfect cleanliness is better than the 
use of any chemicals. 



The Common Drinking Cup, Towel, 
and Wash Rag 

nr^HE use of the common drinking cup and 
common towel has not yet been entirely 
abandoned. Health Departments warn against 
the dangers which lurk in the abuse of this sani- 
tary principle. Although the majority of busi- 
ness places, offices, restaurants and public drink- 
ink places have adopted the use of sanitary cups, 
there are a few who have failed to carry out this 
hygienic requirement. It consequently remains 
for the public to demand the complete elimination 
of the disease-breeding drinking cup. The possi- 
bility of infection with tuberculosis, diphtheria, 
influenza and venereal disease through the agency 
of a common drinking utensil, is now accepted 
without dispute. 

The public is also warned to avoid the com- 
mon drinking ladles and tin cups w^hich we some- 
times see chained to the public drinking fountains 
and wells in parks and summer resorts. Children 
especially should be cautioned against their use. 
Patronage of street venders selling lemonade and 
other soft drinks should be discouraged because 
they do not usually have proper facilities for 
cleansing the glasses. Soda fountain dispensers, 
(180) 



Drinking Cup, Towel, and Wash Rag 181 

restaurants and other public drinking places 
should be held strictly responsible for infractions 
of the law dealing with this matter. The Penn- 
sylvania State Law reads as follows : 

'Those responsible for establishing or con- 
ducting any public drinking places in the Com- 
monwealth of Pennsylvania are hereby forbidden 
to furnish or permit others to furnish or keep 
any common drinking vessel for common use at 
any such drinking place provided this rule and 
regulation shall not preclude the use of vessels 
which are cleansed by washing after individual 
use. Public places within the meaning of this 
regulation shall include common carriers, private, 
public, parochial or Sunday Schools, industries, 
factories, theatres, shops, hotels, etc., etc.'' 

Of no less importance is the common towel. 
It is the ''mixing bowl" of dirt, germs and filth 
and is a fertile focus of distribution of disease. 
Sore eyes, skin affections and venereal disease 
may be contracted through this breach of per- 
sonal hygiene. In large industrial establish- 
ments, where the supply of individual toweling 
would entail a large cost to employers, this 
problem has been solved by requesting each 
employe to furnish his own towel. 

Places which furnish towels should provide 
individual towels or paper toweling. The law 



182 Preventive Inoculation 

in this respect reads "No person or persons or 
corporation within, the Commonwealth of Penn- 
sylvania shall furnish for public use any towel 
unless such towel be laundered or discarded after 
each individual use/' 

Attention is also called to the indiscriminate 
use of the family wash rag. Although the likeli- 
hood of infection from this practise is slight, yet 
the danger is nevertheless present and no one can 
afford to take chances. No one would think of 
using another's tooth brush and the same should 
apply to the wash rag. Children who are pro- 
vided with an individual face rag, learn the im- 
portance of personal hygiene in childhood and 
apply this principle to larger measures of sani- 
tation in later life. 



Preventive Inoculation 

TN these days of advanced medical science we 
aim to prevent disease on a large scale by 
producing an active immunity in the body against 
the more common and serious diseases. Small- 
pox has been practically eliminated by thorough 
vaccination. Typhoid fever has ceased to be 
a serious menace in the military service by 



Preventive Inoculation 1<S3 

reason of typhoid inoculation. Health officials 
are now planning to protect all school children 
against the ravages of diphtheria by a so-called 
toxin antitoxin injection. Some of our prominent 
experimentors are now recommending preventive 
inoculations against pneumonia which in large 
cities heads the mortality list. 

Measures of sanitation have played an im- 
portant part in the prevention of disease, but 
these have their limitation. If one city should 
adopt all the precautions necessary to safeguard 
the health of its residents and should the adjoin- 
ing community ignore these same principles of 
prevention, disease will continue in the first com- 
munity by reason of constant commercial inter- 
course with its neighbor. This is well explained 
by our increase in typhoid fever cases in the fall 
of each year. Residents of this city, traveling to 
other communities where public health measures 
are not stringent may become infected with dis- 
ease which they bring to their homes where 
further infection takes place. 

Because of this inequality in the sanitation 
in various cities and townships it has become 
necessary to adopt an added measure of pre- 
caution against disease, commonly called vaccin- 
ation. This protection consists of the introduction 
into the body of small amounts of the poisons or 



184 Preventive Inoculation 

toxins of the specific diseases, for the purpose of 
producing in the blood of the individual active 
substances called antibodies. For each disease, 
however, there must be a specific vaccine or 
antitoxin. It, therefore, requires a special in- 
oculation for every disease which we desire to 
prevent. Inasmuch as there are only a few dis- 
eases against which we have positive preventive 
inoculation, there is no reason why every indi- 
vidual who is required to travel from place to 
place should not avail himself of these protec- 
tions. 

The military authorities have recognized the 
extreme value of these vaccinations. Men con- 
gregated from all parts of the world in the 
cantonments are liable to bring disease with them 
and endanger the health of all the military forces. 
In actual military operation, contact with prison- 
ers of war from infected districts may cause 
dissemination of disease in prison camps. Vac- 
cination has worked wonders in reducing such 
liability of disease. We do not have, unfortun- 
ately, an antitoxin for every disease. Science, 
however, knows no limitations. It is probable 
that the next decade will bring forth many mar- 
velous achievements along the lines of preventive 
inoculations against all infectious diseases. 



Clean Up Week — A Health Measure 

/^LEAN Up Week always results in better 
and healthier surroundings during the 
heated season, reduces considerably the infant 
mortality and is of extreme value in bringing 
about a greater freedom from, such annoying and 
disease bearing pests as flies and mosquitoes. 
People have been more or less ''boxed up" in 
their homes during the winter months; rubbish 
and waste have accumulated, the carpets, mat- 
tings and draperies have collected dust and cellars 
have been the dumping heap for refuse. Clean 
Up Week, therefore, gives the housekeeper an 
opportunity to get rid of waste which would, if 
not removed, become a menace to the health of 
the occupants of the home and act as a breeding 
place for vermin and disease. 

Start early and make a complete survey of 
the home. Clean it out from roof to cellar. 
Begin on the housetop; remove all debris, repair 
the leaks and if necessary apply a new coat of 
paint to the roof. Clean the attic of old, useless 
and dust collecting furniture, carpets, rags, 
trunks and other rubbish. Make a clean sweep 
upon the cobwebs, dark corners and dust laden 
picture frames. Open the windows and let the 
sunshine in, for it is nature's best germicide. 

Carpets, rugs and mattings should all be taken 

(185) 



186 Clean Up Week 



up and thoroughly cleaned, and the floors and 
woodwork scrubbed. Soap, hot water and a little 
washing soda, and the scrub brush are the how- 
itzers which can successfully combat the common 
enemy — dust. Invade every hiding place in the 
kitchen where filth may accumulate. Plug up the 
rat and mice holes; putty and paint the cracks 
where vermin may propagate. 

The cellar should receive a special cleaning. 
A fresh coat of whitewash applied to the walls 
will add freshness and brightness to its appear- 
ance. Inspect the plumbing and keep the pipes 
clear of rubbish heaps. Notify the Division of 
Housing and Sanitation of leaks from neighbor- 
ing premises which are injuring your property 
and endangering the health of your family. 

Gather all the tin cans, discarded and broken 
bottles and boxes from the back yard and alley. 
Pull up the weeds and prepare the soil for the 
growth of flowers, plants and vegetables. The 
humblest home may be made attractive by a gar- 
den display, by climbing vines or by adorning the 
windows and porch with flower boxes. The 
greater the plant exhibit, the less will be the area 
for the accumulation for waste and refuse. Foli- 
age adds beauty and cheerfulness to the home. 

Do not throw the collected waste into the 
back alley or onto vacant lots to be scattered by 



Diseases Transmitted by Domestic Animals 187 

the wind. Put all the refuse in covered recep- 
tacles and then place these near the street curb 
on the regular collecting days to be gathered and 
carted away. 

Diseases Transmitted by Domestic 
Animals 

'' I ^HE public seems to be little informed of the 
diseases that may be transmitted through 
the agency of domestic animals. People will shun 
places that are placarded for communicable dis- 
eases, but will thoughtlessly pet a cat or a dog 
that has come from such an infected home. Cats 
in particular are known to have transmitted 
whooping cough and diphtheria. Beware of the 
cat that sniffles. 

Cases are on record in which diphtheria has 
been contracted from infected chickens and squabs 
and in like manner chickens have contracted 
diphtheria from human beings afflicted with this 
disease. A similar charge hVs been registered 
against canaries and parrots, but the evidence is 
not entirely convincing. If they are sick, how- 
ever, they should be carefully watched. 

Hydrophobia has resulted from the bites of 
cats, horses, cows, w^olves and even skunks, but 
the bite of the dog is the chief source of rabies. 



188 Diseases Transmitted by Domestic Animals 

The rabid dog presents two kinds of madness; 
one in which the dog is quiet, drowsy and has 
progressive weakness and paralysis beginning in 
the hind legs, and neither attempts to bite nor 
run away. The excited form manifests itself in 
irritabihty, and the animal runs about frothing at 
the mouth, barking and snapping at every one 
and finally succumbs to physical exhaustion. 
When the throat muscles are paralyzed, the dog 
shows fear of water. The muzzling of all dogs 

^ will prevent the transmission of hydrophobia. 

ll Tuberculosis is widespread in cattle and not 

^1 uncommonly as many as 70 to 80 per cent, of 

the cows in a herd have been found to be infected. 
It is now conceded that man may become infected 
by bovine tuberculosis through the ingestion of 
raw milk or its products (butter and cheese) 
when derived from infected cows. Diseases or 
inflammation of the cow's udder, may contam- 

I inate the milk with septic germs, producing in 

man what is known as septic sore throat. 

Typhoid fever and scarlet fever can be trans- 
mitted by infected milk that has been contam- 
inated during the handling, and not as the result 
of these diseases in cattle. It is for this reason 
that the most Health Departments require the 
pasteurization of milk. 

Glanders is a disease of horses affecting the 



Diseases Transmitted by Domestic Animals 189 

nose, glands of the mouth and neck, and finally 
extending to the lungs. Sometimes it manifests 
itself in the form of pustules over the chest. 
When the affected horse sneezes or coughs, a 
fine spray of the infecting material is distributed 
through the air and in this way man is infected. 
Although few cases occur in man, most of them 
are fatal. 

While infection of man by the foot-and-mouth 
disease is greatly feared, only a few cases are 
on record, and they were of such a mild nature 
that the disease almost escaped notice. A few 
blisters under the tongue, which disappear in a 
few days, are the only manifestations of the dis- 
ease in man. Pasteurizing the milk and cooking 
the meat will destroy the agent of infection. 
Transmission from one animal to another can 
only be prevented by killing the infected animals. 

Trichiniasis is a parasitic disease caused in 
man by eating the uncooked meat of the hog. 
The trichina parasites pass from the intestines of 
man to the various muscles of the body where they 
live, thereby producing muscle pains and other 
symptoms resembling chronic rheumatism. The 
eating of raw meats should, therefore, be avoided. 

Anthrax or wool-sorters disease is contracted 
from infected sheep and cattle by those who comb 
the wool and handle the hides. The disease 



190 Diseases Transmitted by Domestic Animals 

manifests itself in the form of a carbuncle on 
the hand, neck or face, or in the form of general 
blood poisoning. Comparatively few men con- 
tract anthrax, but in those who do the disease is 
a serious one. Anthrax in cattle may be pre- 
vented by vaccination. 

Actinomycosis or lumpy jaw can be acquired 
by men from cattle. The infection is usually 
transmitted by the discharges from the mouth 
and nose of the infected animal. It manifests 
itself in man in the form of a chronic inflamma- 
tion of the lungs. The spread of the disease is 
checked by destruction of the infected cattle. 

Smallpox of cows is now a rare disease. The 
vaccine derived from the purposely inoculated 
cow, has worked marvels in protecting the world 
against smallpox. 

Tapeworms result from ingestion of the un- 
cooked meat of cattle, sheep, hogs and fish con- 
taining the larval or infant forms of these para- 
sites. Tapeworms vary in size from a fraction 
of an inch to several yards in length. They live 
chiefly in the intestines of man. Other parasites 
may lodge in the' liver, spleen and brain. Chil- 
dren may be affected with the larval form of 
tapeworms contracted by association with dogs. 

Ringworm is frequently contracted from cats 
and dogs. Infection may arise by contact with a 



Regulating Rag Shops 191 

diseased patch on these animals that has escaped 
notice. 

Bubonic plague is carried by the rat, guinea 
pig, and ground squirrel and the disease is trans- 
mitted to man by means of fleas. Plague is a 
very serious disease and as such may be classed 
with smallpox. Killing the rats on shore and 
preventing their escape from all ships to the 
wharfs will prevent the introduction of this 
serious disease into our ports. 

Tetanus or lock-jaw results from the infection 
of a punctured wound, cut, or vaccination wound, 
by dirt in or about stables, or by dirt where the 
dung of animals is used for fertilizing purposes. 
Frequently the puncture is caused by stepping 
on a rusty nail. The prevention of tetanus rests 
on the proper surgical care of infected wounds 
and the use of tetanus antitoxin. 

Mediterranean fever may be contracted from 
the use of goats' milk. This disease is prevalent 
in Malta. 



Regulating Rag Shops 

A NOTHER advance made in the preservation 

of the public health is the regulation of 

places where rags, old paper and waste are 

bought, stored or sold. We are all familiar with 



192 Regulating Rag Shops 

the sight of old rag shops which have carried on 
their business in old dilapidated buildings reek- 
ing with foul odor of waste, human and animal 
refuse and endangering life and property by fire 
and the health of residents adjoining. 

All rag shops, second-hand paper shops and 
junk shops, which purchase, store or sell dis- 
carded wearing apparel, cloth, muslin, fabric, 
burlap or waste, or where such materials are 
washed or sorted, are required in many cities to 
obtain a license to conduct such business from the 
Board of Health. This makes it possible for the 
Health Department to keep a constant super- 
vision over the sanitary condition of these places, 
preventing them from becoming public nuisances 
and from acting as distributing foci of disease 
and disease-breeding insects. 

Wearing apparel offered for sale by such 
places must be thoroughly washed and disin- 
fected. The reason for this is self-apparent, when 
we consider that clothing may be assembled from 
places where infectious and communicable dis- 
eases have prevailed. More especially is this true 
of tuberculosis and various skin diseases which 
may be transmitted by soiled clothing. 

As a health measure, no building used for 
the storage, sorting or washing of waste ma- 
terials can be used, in whole or in part, as a 



Sewage Disposal 193 



dwelling, two-family dwelling, rooming house or 
tenement. 

Many rag shops and junk shops have, in the 
past, been responsible for littering the streets in 
the immediate neighborhood with paper and 
waste which had not been properly baled or 
packed, and which were permitted to be blown 
about by the wind. The regulations provide that 
the public highway shall not be used for sorting 
or storage of such waste and that droppings from 
the same be avoided by packing and baling. This 
is one of the ways in which city officials hope 
to obtain cleaner streets. 

As a measure of protection against fire there 
should be no communication between a garage 
and any building used for the storage of rags, 
papers and waste, nor should any garage be used 
for the storage of such materials. 

Co-operation of the public is earnestly re- 
quested to maintain these places in a clean and 
orderly manner. 

Sewage Disposal 

'T^HE disposal of fluid waste from homes, 
business and industrial plants which com- 
prises all materials carried away by the waste 
pipes is a health matter. These fluid wastes 

13 



194 



which include human excreta must be so disposed 
of as not to contaminate our fresh water sup- 
phes. What is commonly known as sewer pipes 
consist of huge pipes sometimes very large in 
calibre to carry away the fluid waste gathered 
from all dwellings, and buildings. These sewer 
pipes empty in some stream which is not used as 
a source of water supply. If the stream is used, 
the sewerage is emptied far away from the sup- 
ply intake. In other words the sewerage is so 
well diluted before it reaches the intake for fresh 
water supply that it is comparatively harmless. 

In some places there is a separate sewer for 
the rain water which runs off the streets, and a 
separate one for the fluid wastes from homes and 
buildings. The combined system of taking all 
wastes is in common use. 

Small localities dispose of their sewage by 
passing it into closed tanks where the wastes 
digest themselves being confined from contact 
with the air. These are called digestion tanks. 
Some places treat the sewage with chemicals to 
render it harmless. 



Refuse Disposal 

A MONG the things which a city or community 
must dispose of to prevent disease are 
garbage, ashes, rubbish, street sweepings, man- 
ure, and dead animals. One of the safest ways 
of getting rid of these materials is by burning. 
This method is used largely abroad. All waste 
is collected together and burned. The American 
system is different. Each of these refuse ma- 
terials is collected and carted away separately 
and then either burned or reduced. By reduction 
is meant that garbage for instance is tanked and 
boiled, the various ingredients separated by com- 
pression and the byproducts such as grease, 
chemicals and ''tankage" are used respectively 
for soaps and for fertilizers. 

Ashes are commonly used for filling in 
ground. Rubbish is sorted for valuable metals, 
tins and paper and then burned. 

Garbage is sometimes disposed of by feeding 
the hogs. In such instances the piggeries must 
be kept in a clean and sanitary manner, away 
from the built-up sections of the cities. The 
chief objection to this method is that the feeding 
of hogs with garbage gives rise to objectionable 
odors and favors the breeding of flies. Proper 
methods of control however can render this 
objection void. 

(195) 



PART V 
FOODS AND WATER 



Lower Priced Foods With High 
Nutritive Value 

T T may be interesting to know that a large 
variety of food products rich in nutritive 
value may be purchased at reasonable prices. 
For instance potatoes, our most widely used vege- 
table, have 1.8 per cent, of proteid, o.i per cent, 
of fat and 14.7 per cent, of sugars or carbohy- 
drate. Rice on the other hand contains about 
five times as much of these food essentials and 
may be prepared in a variety of ways suitable 
to the appetite. Reference to the various cook 
books shows recipes for a number of dainty and 
palatable dishes of rice. 

Onions which at times command a high price 
have only a small food value. This is also true 
of such vegetables as cabbage, lettuce and celery, 
the greater bulk of which is made up of water 
and cellulose. Far more valuable than these are 
(196) 



Lower Priced Foods 197 

peas and beans which are rich in proteid and 
carbohydrate content. 

Mush is also recommended as a substitute for 
the more expensive foodstuffs, for its nutritive 
value places it among the foremost nourishing 
table commodities. 

As a suitable substitute for butter on your 
bread we may return to our childhood favorite — 
molasses, which is comparatively cheap and 
capable of producing abundant heat and energy. 

Milk and cheese are within reach of us all and 
are very rich nutritious foods. Sour milk pre- 
pared especially as a table delicacy is a valuable 
and nourishing product. Sour cream, used in 
many ways by foreigners is also a palatable and 
heat generating food. 

Among the various other commodities which 
have high food values and yet come within reach 
of all wage earners are cocoa, macaroni, oatmeal, 
dried fruits, canned salmon, mackerel and cod 
fish. 

In recommending foods of low price and high 
nutritive value it must be remembered that pala- 
tability is a principle of dietetics which must not 
be overlooked. Foods must be prepared to appeal 
to the appetite, for there is a greater secretion of 
the digestive juices and metabolism (digestion) is 
enhanced when edibles are attractive and pleasing. 



198 Lower Priced Foods 

Nor is it the intention to request the house- 
wife to reduce the variety of table delicacies, for 
a mixed diet is most desirable. When the same 
menu is repeated too often there is a tendency to 
lessen the appetite. While some foods may have 
relatively great heat producing value, they may 
contain a large proportion of indigestible pro- 
ducts which have no food value, but which act as 
"fillers" or "roughage" tending to make up the 
bulk of food and acting as laxative agents upon 
the bowels, thus serving a valuable purpose. 

The housewife should therefore remember the 
three essentials necessary for a well balanced diet 
if she desires to limit herself to the cheaper foods 
— palatability, variety and digestibility. 

The following is a list of common foodstuffs 
and their relative nutritive values. 





Food Units 


1 lb, potatoes, 


370 


' 


1 lb. rice, 


1610 


* 


1 lb. corn meal, 


1680 


( 


1 lb. fish, 


1000 


< 


1 lb. bread, 


1215 


* 


1 lb. dried beans, 


1820 


' 


1 pint milk. 


320 


< 


2 eggs, 


160 


( 


J4 lb. American cheese, 


530 


i 


1 ounce butter, 


250 


' 


,J4 pint molasses, 


640 


< 


1 lb. apples (edible portion) 


290 


i( 


1 lb. bananas, " 


460 


(< 


1 lb. oranges, " 


240 


" 



Handling of Food 199 





Food Units 


1 lb. onions, (edible portion) 


220 


1 lb. celery (exclusive of waste), 


85 


1 lb. cucumbers, " " " 


80 " 


1 lb. lettuce, 


90 


1 lb. carrots. 


210 


1 lb. cauliflower, " 


140 " 


1 lb. cabbage. 


145 



Handling of Food and its Relation 
to the Public Health 

r^ ONTAMINATION of food through contact 
with unclean hands, street dust, flies and 
vermin is undoubtedly the source of many cases 
of disease. The protection of the public from 
this source of sickness is a very important prob- 
lem, which must be solved not only by legislation 
but by awakening the public interest to the im- 
portance of personal cleanliness and the principles 
of sanitation. It is only then that the careless, 
unclean food handler will be boycotted and com- 
pelled to give up his business or to adopt the 
recognized sanitary methods. Investigations 
were conducted in various cities of foods exposed 
to street dust and it was found that some of the 
foodstuffs were so contaminated as to arouse 
anyone's sense of disgust. 



200 



Handling of Food 



There are health regulations in some cities 
which prohibit the sale of exposed fruits, vege- 
tables and other articles of diet eaten uncooked 
unless they are thoroughly screened and pro- 
tected from flies and unless they are on elevated 
stands 24 inches above the sidewalk and pave- 
ment. The approach of warm weather us- 
ually induces the establishment of many curb 
markets, when the above regulation should be 
strictly carried out, in order to lessen the danger 
of purchasing street dust with vegetables. 

One of the greatest sanitary achievements 
brought about in Pennsylvania within the last few 
years has been the regulation of the milk supply. 
This product has for a long time been responsible 
for a large proportion of cases of typhoid fever, 
scarlet fever, epidemic sore throat and diarrheal 
troubles. 

Dealers have recognized the importance of 
handling only clean, pure, wholesome milk, and 
have gained greater patronage and favor because 
of their attention to the minute and necessary 
details in the handling of this commodity. If 
the consumer does not exercise an equal amount 
of care in handling this product at home by 
preventing its contamination and spoiling, all 
the previous precautions taken by the dealer will 
prove valueless. 



Handling of Food 201 

Health departments have corps of inspectors 
who are keeping constant vigilance over the 
sanitary condition of slaughter houses, storage 
houses, markets, shops and places where meats, 
poultry, fish, game and shell-fish are sold or pre- 
pared for use as food. In fact, these places are 
required to have a license in cities from the Board 
of Health to conduct their business. This re- 
quirement therefore acts as a stimulus to food 
dealers to maintain their places of business in a 
clean and sanitary manner. 

The public health is further safeguarded in 
many States by a law which requires all employes 
in restaurants, hotels and dining cars to be ex- 
amined twice annually for the presence of com- 
municable diseases. 

Thus it is seen that every effort is being made 
to protect the public from avoidable sickness 
through the careless handling of the food we eat ; 
but in this connection, the co-operation of all food 
merchants is essential to bring about successful 
results. 



A Plea for Sanitary Restaurants 

T N order to obtain better sanitary conditions in 

public eating places and thus guard the health 
of the community, an appeal is made to each and 
every proprietor of the hotels, restaurants and 
drug stores, requesting that they co-operate with 
the health authorities in excluding from employ- 
ment cooks, waiters, chambermaids, kitchen help 
and others who suffer from certain diseases and 
in making provisions for the sanitary conduct of 
restaurant eating utensils, drinking cups and 
wash rooms. 

For the benefit of those who desire to secure 
public patronage by establishing the reputation 
of complying in all details with the recommenda- 
tions of health authorities, the following meas- 
ures are outlined for their guidance : 

Restaurants should be provided with proper 
and ample kitchen facilities for washing and 
cleansing all kitchen utensils and with a proper 
supply of hot and cold water. Proprietors or 
persons in charge of public eating places should 
not use drinking vessels, dishes, spoons, knives, 
forks, finger bowls or other eating materials 
which have not been thoroughly cleansed with 
scalding water after each individual use. The 
kitchen and dining rooms should be kept in a 

(202) 



A Plea for Sanitary Restaurants 203 

clean and orderly manner at all times, and meas- 
ures should be taken to prevent nuisances created 
by the dissemination of odors, vapor and smoke. 
Air shafts, fans, forced air or other approved 
methods should be installed when necessary to 
control such nuisances. 

All rooms used for cooking and preparing 
foodstuffs should have floors and side walls so 
constructed as to exclude vermin, rats and mice, 
and the plumbing should always be kept in good 
repair and free from leaks. Washrooms con- 
nected with restaurants for the use of patrons or 
employes should be provided with individual 
towels to be discarded or laundered after each 
use. 

Proprietors of hotels and other public eating 
places should maintain a medical inspection of 
cooks, waiters, chambermaids and kitchen help 
for the purpose of excluding from employment 
those who are suffering from trachoma, active 
tuberculosis of the lungs, open skin tuberculosis, 
venereal disease, open external cancer, and bar- 
ber's itch. Medical examination of these em- 
ployes should be performed at least twice a year 
by a reputable physician and certificates of the 
physical examinations filed with the health de- 
partment. Special care should be exercised by 
the medical examiner to bar typhoid carriers 



204 



Care of Milk in the Home 



from employment in such places, since contam- 
ination of the food may readily spread the disease 
to the patrons. 

Proprietors will find it to their advantage to 
adopt the measures recommended, for public 
sentiment is strongly adverse to the patronage of 
unclean restaurants. 



Care of Milk in the Home 

/^^ REAT efforts have been made by health 
departments to secure pure milk for the 
public. Rules and regulations have been formu- 
lated for the proper care and handling of the milk 
from the source of production until it reaches the 
consumer. It is at this juncture that the responsi- 
bility of the consumer begins, and it is his duty 
to continue this strict care so that the milk shall 
be kept pure until used. 

It is, therefore, most important that the con- 
sumer shall co-operate with the health officials 
and the dealer, by taking proper care of the milk 
in the household. 

It is just as necessary to keep the milk clean 
and cool at home as to request such care from the 
dealer. After pasteurization the dealer is re- 



I 



Care of Milk in the Home 205 

quired to cool the milk to 50° Fahrenheit and 
deliver it to the consumer within 24 hours. If 
the consumer does not exercise equal care to 
keep the milk cool until used, and allows it to 
stand in a warm room, germs will rapidly mul- 
tiply in the milk. 

Do not allow your bottle of fresh milk to 
remain on the door step too long in the morning, 
during the warm weather, as exposure to heat of 
the sun will favor the growth of bacteria. The 
bottle should be taken in at once and placed in 
the refrigerator. Milk should be placed in a 
separate compartment in the refrigerator and 
kept covered — as odors of meats and vegetables 
are readily absorbed by uncovered milk. The re- 
frigerator itself should be free from odor and 
kept clean and well-drained. There should not 
be any direct connection between the drain pipe 
of the refrigerator and the sewer unless properly 
trapped. The food compartments of a refriger- 
ator should be scalded at least once a week, with 
a hot solution of washing soda. A small amount 
of spilled milk and sour or uncovered foods will 
soon contaminate the refrigerator. 

Keep the milk in the bottle until ready for 
use and then pour out only as much as is immed- 
iately required. Wipe the mouth of the bottle 
with a clean towel before removing the cap which 



206 



Care of Milk in the Home 



should then be carefully lifted and rinsed in clean 
running water before being replaced. If the cap 
is broken, place an inverted tumbler over the 
mouth of the bottle. Do not pour back into the 
bottle unused milk which has been exposed to the 
air or otherwise contaminated, as it will spoil 
the rest of the milk. 

Household receptacles for milk must be kept 
scrupulously clean. After use these utensils 
should be rinsed, scalded and set away unwiped, 
bottom upwards, to dry, as they are kept in much 
better condition this way than when washed in 
dish water and wiped with the ordinary dish 
towel. 

Scald the milk bottles before returning them 
to the dealer. After all the milky film has been 
removed by cold water, wash carefully in hot 
water and stand the bottle upside down in a clean 
place to dry. Insist that the milkman shall re- 
move all bottles daily. Under no circumstances 
use milk bottles for turpentine, vinegar, kerosene, 
or for any liquid other than milk. 

Tuberculosis, scarlet fever, diphtheria, ty- 
phoid fever, septic sore throat and infantile 
diarrhea can be caused by contaminated milk. If 
the dairyman or dealer should come in contact 
with these diseases, either in his own home or 
otherwise, his careless and improper handling of 



What You Should Know About Milk 207 

the milk can pass the infection along. If there 
is a contagious disease in the home, the nurse 
should not handle the family milk. Health de- 
partments forbid the removal of milk bottles 
from such a house without a permit and then 
only after sterilization. 

The germs of diphtheria and typhoid fever 
can be transmitted by so-called ''carriers." Sev- 
eral cases of typhoid fever in New York have 
been traced to a cook called "Typhoid Mary," 
who contaminated food through the perspiration 
exuding from her fingers. Such an individual 
could readily infect the milk. 



What the Public Should Know 
About Milk 

TT^ARIOUS names are used in connection with 
the sale of milk and its products, which 
may be confusing to the purchaser. Among the 
various products on the market are pasteurized, 
evaporated, condensed, desiccated, milk powder, 
skim milk and modified milk. 

Pasteurized milk is a product which has been 
heated to 157° Fahrenheit for ten minutes or 
longer, whereby- the activity of the bacteria is 



208 What You Should Know About Milk 



very much diminshed or destroyed. Two pro- 
cesses of pasteurization are in common use. In 
the ''holder" process the milk is held at 145° 
F. for thirty minutes. In the "flash" pro- 
cess the milk is heated to 160° F. and held at 
this temperature for thirty seconds to one minute 
and then quickly cooled. Practically 98 per cent, 
of the milk sold in the large cities is pasteurized. 
This procedure, when properly done, protects the 
consumer from infection with disease-breeding 
germs, protects the infants from bowel troubles 
and increases the keeping quality of the milk. 

Evaporated or condensed milk is a concen- 
trated form of milk in which the watery substance 
of the milk is largely removed. Before the en- 
forcement of the pure food laws there were on 
the market many brands of the so-called "con- 
densed cream/' "evaporated cream" or "con- 
densed milk," either with or without the addition 
of cane sugar, which were, in reality, only con- 
centrated skimmed milk. At present the label on 
the can must correctly describe the contents. 
Canned milks have the advantage of being free 
from germs detrimental to health. 

Desiccated milk is the product reduced to 
powdered form. When the proper amount of 
water is added to this dried milk, the mixture 
closely resembles ordinary milk, and is used by 



What You Should Know About Milk 209 

bakers for many purposes where milk is required. 
Some of the powders on the market are dried and 
pulverized skimmed milk. 

When fat is removed from whole milk either 
by hand or by a separator, the remaining pro- 
duct is called skimmed milk. It is an excellent 
food in spite of the absence of the fat, since there 
remain the proteids, sugar and mineral salts. 

Adulterated milk is one to which water has 
been added, or from which the fat has been re- 
moved or where preservatives have been added. 
The fat contents of milk should be at least 3.25 
per cent, and the total amount of solids, which 
includes proteids, fat, sugar and salts is 12 per 
cent. 

In order to prevent the souring of milk, 
various chemicals used as adulterants are some- 
times added. Among these substances are bak- 
ing soda, boric acid, peroxide of hydrogen, and 
formalin. The use of these adulterants is illegal, 
where the milk is intended for human consump- 
tion. 

The public should also be familiar with the 
types of cream upon the market. Two grades are 
recognized — ''heavy," containing 25 to 30 per 
cent, fat, and 'light" with 12 to 15 per cent. fat. 
Thin cream may be thickened with gelatine or 
sucrate of lime. When cream is subjected to a 



210 



Milk a Perfect Food 



high pressure in an apparatus called a homo- 
genizer, the fat globules are disrupted and a 
homogeneous emulsion is formed. By this means 
a i6 per cent, cream acquires the body and tex- 
ture of 20 to 25 per cent, cream. This change is 
physical, and as nothing has been added or sub- 
tracted, it cannot be said to be adulterated. It 
should, however, be called "homogenized cream." 



Milk a Perfect Food 

"T^RINK more milk! In spite of its increased 
cost, milk still remains one of the cheapest, 
most easily digested and most nourishing foods. 
With its other by-products, it comprises about 
one-sixth of all foods eaten by the average family. 
One glass of milk is equal in value to either : 

Two krge eggs. 

A large serving of lean meat. 

Two moderate sized potatoes. 

Five tablespoonfuls of cooked cereal. 

Three tablespoonfuls of boiled rice. 

Two slices of bread. 

This food product is generally considered a 
perfect food because it contains parts of all the 
different table commodities. It contains the pro- 



Milk a Perfect Food 211 

tein found in meat, the fat in yolk of tgg and in 
bacon, the sugar as contained in candies, desserts 
and table sugar, the salt as contained in mackerel 
and herring, and the water as obtained from the 
spigot. It also contains ferments which are very 
valuable in digestion, gases and antitoxins which 
are all important to the body. The average pro- 
portion of these constituents is as follows : Albu- 
men 4^ per cent., butter fat 3^ per cent., sugar 
4>4 per cent., salt ^ per cent., and 87 per cent. 
of water. 

To be healthful and wholesome, however, 
milk must be clean and free from disease-breeding 
germs. Under usual circumstances milk contains 
many bacteria, but these are harmless and often 
beneficial. When in large numbers, they indicate 
that the milk has been imperfectly handled, that 
it is dirty or that it has not been kept at a suffi- 
ciently low temperature. The number of germs 
in milk is an index as to its sanitary quality. 
This determines the grade of milk, which is 
designated as pasteurized, certified, inspected and 
market milk. In some cities, milk is designated 
as A, B and C quality, depending upon the num- 
ber of bacteria present. 

Dirty milk, containing large numbers of bac- 
teria, spoils readily through fermentation or 
putrefaction. The former is commonly called 



212 Pure Water 



souring, while the latter is a decomposition ren- 
dering it useless as food. Sour milk is not harm- 
ful and, in fact, may be beneficial. For grown 
people sour milk obtained from clean pure milk 
is just as nutritious and wholesome as fresh milk. 
The bacteria which cause it to become sour have 
a beneficial effect upon the digestive functions of 
the intestines. 

Two and a half quarts of skim milk contain 
almost as much albumen and yield about the same 
amount of energy as a pound of beef. It must be 
obtained from pure milk in order to be a safe 
food. 

Buttermilk is another valuable and whole- 
some by-product of milk, which has the food value 
of skim milk and the added advantage of milk 
acids. 



Pure Water 

13 Y pure water is meant water which is free 
from disease germs, is crystal clear, free 
from odor or taste, and is palatable. There are 
waters which are quite pure from the standpoint 
of freedom from disease organisms but are objec- 
tionable because they have an odor or a bad taste. 
Bad odors arise in water supplies secured from 



Pure Water 213 



streams which are frozen over for long periods, 
preventing the proper airing or oxidation of the 
water. The gases which arise from the decom- 
position of organic matter and from water plants 
are mixed with the water and are not allowed to 
be given off by the covering of ice. Again in the 
fall when the temperature of the surface of the 
water changes there is a circulation of water 
from the bottom to the top by reason of the 
differences in temperature of top water and bot- 
tom water. As the bottom water comes to the 
top it brings with it the odors of plants and 
decomposing matter. 

In large cities the water supply is taken from 
neighboring streams and filtered by means of 
huge filter beds of sand. Some localities draw 
their water from great distances, from the 
mountains or from sunken wells. 

If water is taken from rivers, such supply 
must be protected from contamination by waste 
products emptied into them from factories, va- 
rious industries, or from sewers of neighboring 
towns. 

Water may be purified by storing it in large 
tanks. The solid particles in it will settle to the 
bottom and the exposure to the sun and air 
gradually kill all the disease germs. It may also 
be treated by certain chemicals such as chlorine, 



214 Pure Water 



chlorinated lime, alum, ozone, and sulphate of 
iron. These processes when used alone are not 
as safe nor do they give as palatable water as 
when combined with a process of filtration. 

The diseases commonly conveyed by impure 
water are typhoid fever, cholera, dysentery and 
diarrheal conditions. In some localities the water 
is said to convey goiter. When water pipes are 
not properly lined, or the water is treated by 
strong chemicals causing the lining of the pipes 
to be "eaten away'' then lead poisoning may 
develop from drinking the water. 

When away in the country where there is 
a pump supply such water is safe only if the 
well is protected from contamination from privy 
wells and from the surface dirt about it by proper 
concrete reinforcement. 

Wherever the purity of the water is question- 
able it should be thoroughly boiled. 

DISEASES CONVEYED BY ICE 

Natural ice which is cut from streams and 
lakes which are contaminated by bacteria may 
convey typhoid fever and other intestinal dis- 
orders. Artificial ice made from filtered water 
is safe. Handling of ice by ice men may be a 
source of infection. Therefore all ice should be 



Meat and Cattle Inspection 215 

thoroughly washed before it is used. It is safer 
to use cooled water than ice water obtained from 
melted ice. 



Meat and Cattle Inspection 

A S a safeguard to the pubhc health, meats of 
all kinds, poultry and fish are subject to 
inspection, by health officials. The meat of cattle, 
sheep and hogs intended for shipment between 
the States must be passed upon by Federal gov- 
ernment inspectors. Such inspection takes place 
before the cattle are killed and afterward. The 
inspector usually passes through the pens where 
the livestock is awaiting slaughter and picks out 
those which look sick as evidenced by drooping 
heads. The sick cattle are separated and isolated 
and are kept under observation and treatment. 

Those which pass inspection are slaughtered. 
The head, lungs, liver and intestines are then 
examined for signs of tuberculosis and other dis- 
eases. When extensive lesions of tuberculosis 
are found the entire carcass is condemned, as 
unfit for human use. If tuberculosis is limited 
to certain parts of the body and is not extensive, 
then only that part of the carcass is condemned. 



216 



Meat and Cattle Inspection 



Beef and pork may also be condemned if they 
contain certain parasites because they may cause 
in man what is commonly called beef and pork 
tapeworms. Hog cholera is a cause for con- 
demning hogs and swine. 

Small slaughter houses which do not ship 
their meats out of the state are inspected by the 
local authorities. There are various laws which 
require the sanitary handling of slaughter places 
so that they may not be a nuisance to nearby 
residential districts. 

Poultry and fish inspection are under juris- 
diction of the local health officials. Live poultry 
is not subject to supervision. Killed poultry and 
fish must be fresh, of good color and free from 
odor of decomposition. 

In Pennsylvania, meats, poultry, fish, butter 
and eggs must not be kept in cold storage houses 
longer than one year. It is believed that after 
this period they undergo decomposition when they 
are dangerous to public health. Some states do 
not limit the time of storage. 

Every place selling or storing meats, poultry, 
fish or shell food is generally required by boards 
of health to secure a license. This permits the 
health officials to investigate the sanitary condi- 
tions of places where foods are kept or ofifered 
for sale. 



PART VI 

TALKS ABOUT INFANTS AND 
CHILDREN 



Birth Registration an Important 
Subject 

Tf EW people appreciate the importance of hav- 
ing the births of their children registered. 
In fact, a certificate is only found missing when 
the child, in after years, applies for a copy of the 
record to obtain certification of age for working 
papers or some legal matter. 

During the World War many American 
born children of foreign parentage have ap- 
plied to health departments for records of their 
birth to exempt them from service abroad. If 
these records are not on file, it is often impossible 
to prove their citizenship. Other advantages that 
might be mentioned by having a record of the 
birth on file are proof of legitimacy, identity, or 
in order to obtain inheritance. Many insurance 
companies and industrial plants now require some 

(217) 



218 



Birth Registration Important 



official proof of the age or citizenship of those 
working for them. The question is so important 
that the births of all children should be registered 
and no parent should neglect to give his child the 
advantage of this — a part of his legal birthright. 

Other legal matters for which a certified copy 
of a birth record is necessary may be quoted as 
follows: — Age for school admission, age for cer- 
tain classes of employment, age of legal responsi- 
bility, age of consent, age of majority, age of 
differentiating juvenile from adult court cases, 
obtaining passports and various other matters 
for personal gain or protection. 

To the community the advantages likewise 
are many. Proper birth rates, as well as the 
rates of infant deaths, are figured on the number 
of births reported. In this manner the Depart- 
ment of Health is able to direct its efforts to that 
part of the community where the greater number 
of these children die. In addition to this, the 
advantage for admission to school or the proper 
working age may be ascertained. This serves as 
a protection for the community and the em- 
ployer, as well as for the child. 

For any of these purposes a copy of the en- 
tire record of births "exactly as filed" may be 
obtained from the Division of Vital Statistics of 
the Health Department. 



Preventing Blindness Among Babies 219 

During the war period, the Navy Department 
required each appHcant for service to verify his 
birth record. Too frequently it was found that 
no record of birth had ever been filed and this 
necessitated the appHcant finding other evidence 
to prove his citizenship. All parents should in- 
vestigate whether or not the births of their chil- 
dren are on record, and, if not, should take im- 
mediate steps toward having the births officially 
recorded. 



Preventing Blindness Among Babies 

TT is generally agreed by the medical profes- 
sion that the eyes of every infant should be 
treated immediately after birth by the instillation 
of a suitable antiseptic solution as a preventive 
measure to guard against a very dangerous dis- 
ease which is technically called ophthalmia neona- 
torum. This routine practice in every case is 
generally adopted and in some localities required 
by law because a large number of babies have 
been blinded as a result of a virulent infection of 
the eyes which sometimes occurs soon after 
birth. Physicians are in a position to know that 
blindness from this cause is entirely preventable, 
and they appeal to the parents of children to 



220 Preventing Blindness Among Babies 

regard sore eyes among infants with serious 
consideration. 

The most impressive lesson of ignorance on 
this subject matter is learned when visiting the 
several schools for blind children where hundreds 
of bright, intelligent youngsters are taught to 
compete with those who have the advantage of 
the sense of sight. About 25 per cent, of the 
inmates of these schools have been blinded by 
babies' sore eyes. Every one of these misfortunes 
could have been avoided. 

It is estimated that one out of every twelve 
persons among the blind population in this coun- 
try can attribute his loss of sight to lack of care 
of the eyes at the time of birth. The amount 
of danger caused by such neglect is far beyond 
comparison to the slight effort of placing a few 
drops of medicine in the baby's eyes at birth. 

Once there is an infection of the eyes, the 
damage done may seriously impair the vision in 
spite of active medical treatment. It is, there- 
fore, essential to adopt adequate measures which 
will prevent any occurrence of the disease. 

Some health departments furnish free of 
charge an antiseptic solution for the treatment 
of the eyes of every child immediately after it is 
born. If these drops were used in every case, it 
is believed that there would be a marked reduc- 



Care of Baby in Hot Weather 221 

tion in the number of inmates of our institutions 
for blind children which, at present, are "monu- 
ments'' indicating neglect upon the part of an 
indifferent public. 



Care of the Baby in Hot Weather 

T^ONT fail to protect the children from the 
effects of the heat. 

Don't take infants on shopping tours. They 
are more susceptible to the effects of heat than 
adults. 

Don't keep the baby on the top floor of the 
house if the first floor is cooler. The temperature 
in the shade outdoors is lower than the tempera- 
ture inside the house. 

Don't keep the children in the kitchen where 
the humidity is greatly raised by the evaporation 
of water in cooking, washing and ironing. 

Don't forget that babies may die in twenty- 
four to forty-eight hours from the effects of the 
heat. 

Don't allow the children to be unnecessarily 
exposed to the direct rays of the sun. Permit 
them to play only in the shade. 



222 Care of Baby in Hot Weather 

Don't forget that babies need more drinking 
water in hot weather than at any other time. 
Cooled water is better than ice water. 

Don't fail to bathe the child daily. It reduces 
the body temperature and induces the child to 
sleep. 

Don't burden the baby with many clothes. 
A clean diaper and a loose cotton slip are all that 
the infant needs and more clothes should be pro- 
vided only when the weather gets colder. 

Don't forget that babies need plenty of sleep. 
Every baby needs twenty hours sleep daily during 
the first month and not less than sixteen hours 
daily up to the end of the first year. A clothes 
basket containing a mattress made of excelsior 
enclosed in a blanket makes a good crib for those 
who cannot afford a better one. Feather pillows 
should not be used in a crib or baby coach. 

Don't fail to protect the babies from the 
annoyance of flies and mosquitoes. These pests 
transmit diseases which often prove fatal, espec- 
ially so during the hot spells. 

Don't wean the baby during the hot weather 
except on the advice of a physician. Ten bottle- 
fed babies die to one that is breast-fed. Feed the 
baby at regular intervals. Improper feeding 
causes the greatest number of deaths from bowel 
troubles. 



Care of Baby in Cold Weather 223 

Don't use soothing syrups to quiet the baby. 
If the baby has loose green passages from the 
bowels, it should receive immediate medical 
attention. 

Don't forget that babies need plenty of fresh 
air. Whenever convenient take them to the city 
parks and recreation piers but always have an 
extra wrap for them in case of sudden change of 
weather. 



Care of the Baby During Cold 
Weather 

nr^HE increasing prevalence of pneumonia 
which has attracted the attention of the 
health officials during the past few years is not 
only conspicuous among adults but also among 
the infant population. Children of tender age 
are especially susceptible to the influences of cold 
weather and more so in times of epidemics of lung 
diseases. Each winter about 25 per cent, of the 
deaths from pneumonia occur among children 
under two years of age. This is sufficient con- 
vincing evidence of the fact that infant welfare 
work should not be confined only to the care of 
babies during the heated term but should be ex- 
tended throughout the year. The prevention of 



224 Care of Baby in Cold Weather 

acute respiratory diseases among the infant 
population is by no means a small problem. 

The prevalence of pneumonia, however, does 
not necessarily mean that babies of tender age 
should be closely huddled about the fireplace or 
confined in stuffy overheated rooms. Fresh air is 
just as essential to the growing child as to the 
adult if not more so. It therefore behooves par- 
ents to maintain a proper temperature in the bed- 
room of the infant to insure sufficient heat for 
comfort, and a proper supply of fresh air to keep 
the atmosphere comparatively free of infectious 
agents. 

Dressing the baby according to the tempera- 
ture of the day is another feature in the proper 
care of the infant which deserves the utmost 
detail consideration on the part of the mother. 
Soiled clothing remaining unchanged on the in- 
fant may predispose to chilling of the body. 

Poorly fed babies are less resistant to the in- 
vasion of disease than the well-fed, robust, 
tenderly nursed child. Too often poverty is re- 
sponsible for conditions of lowered resistance, 
more especially among the infant population. 
Although pneumonia is not particularly a poor 
man's disease, yet it takes its heaviest toll among 
those deprived of comforts and privileges through 
poor financial circumstances. 



Care of Child During Preschool Age 225 

Another factor in the care of the baby is the 
use of home medications. No parent is capable 
of diagnosing the illness of his or her child and 
less fitted to prescribe for him. The baby's health 
cannot be found in the medicine bottle and the 
sooner the public recognizes the importance of 
intelligent and scientific care of the child's ail- 
ments by the trained and skilled physician, the 
better will be the infant's opportunity to combat 
the invasion of disease and to secure the proper 
treatment to avoid premature death. 



Care of the Child During the Pre- 
school Age 

IV/rOST cities have made provision only for the 
care of babies under the age of two, and of 
children of school age, but for some reason or 
other, little attention has been paid to the health 
of the child from the time the visiting nurse dis- 
charges the mother and baby and the time the 
child goes to school. The absence of supervision 
of the child between the ages of two and five opens 
the way for an extensive field of activities which, 
if well directed, may prove very valuable in re- 

15 



226 Care of Child During Preschool Age 

ducing the huge mortahty rate among young 
children. 

It is during this age period that such com- 
municable diseases as measles, mumps, chicken 
pox, scarlet fever, whooping cough and diphtheria 
are prevalent and especially dangerous. Further- 
more, the diseases mentioned are very likely to be 
complicated by pneumonia which is quite fatal 
among children of tender age. 

Aside from considering the importance of 
keeping these children under observation because 
of the sick and death rate among them, it be- 
comes a matter of probably equal significance 
from a standpoint of economy to look after their 
physical condition before commencing their school 
studies. By so doing, a considerable portion of 
the work attending the correction of defects 
among the children of school age could be spared, 
much to the advantage of the school officials and 
to the health of the children themselves. 

Wherever careful physical examinations have 
been made of the first year pupils in schools, one 
child out of every three has been found to have 
some physical defect requiring the attention of a 
physician. In some instances defects had already 
impaired the health or the development and its 
ability to keep up with the normal child. If such 
defects were discovered before the school age and 



Preparing Children for School 227 

were corrected before any permanent injury took 
place, then we would be assured of children who 
were physically prepared to endure the changes 
of school life, and the large number of "repeat- 
ers" in the various grades and of delinquencies 
would be greatly reduced. 

In large families, when the new baby arrives, 
the child which has just passed its infant life is 
no longer the idol of the family and the usual care 
and attention is often shifted to the new arrival. 
Although it is true that most deaths among babies 
occur before the first birthday, it is important 
that the same precautions to preserve and pro- 
mote the health of the infant, be exercised during 
the pre-school age. The problem of supervising 
the care of children between the ages of two and 
five by health departments is therefore a matter 
worthy of consideration. 



Preparing the Children for School 

\X7'lTH the approach of school days, parents 
become particularly anxious concerning 
the welfare of their children about to enter school 
and are very desirous that they should succeed in 
their studies and obtain a thorough education. 



228 



Preparing Children for School 



Mothers busy themselves about their children's 
clothing, books, slates and pencils, but these sup- 
plies constitute only a small portion of the equip- 
ment necessary for the success of the child at 
school. The child must be physically prepared to 
undergo the change of environment from the 
home to the classroom, where conditions are met 
with which reveal physical defects previously 
unrecognized. 

A pupil in poor health will not be able to 
cope with his studies. Being thus handicapped 
he will not only fail to show progress, but may 
finally fall into the backward class. Children 
often become discouraged with school work be- 
cause they are required to make up studies which 
they have missed while absent during the school 
term by reason of sickness. It therefore becomes 
the duty of parents to ascertain the state of health 
of their children and have their physical defects 
corrected before school begins. Start them out 
right with a clean bill of health and they will not 
likely go wrong during the whole school year. 
Do not wait until some one else discovers their 
defects, but take them to your family physician 
with a request for a complete physical examina- 
tion. Slight defects often become greater ones 
after the child enters school, and faults that are 
not corrected during the school age ofttimes re- 



. Preparing Children for School 229 

main uncorrected during later life and may then 
result in deficiency and incompetency in the work 
which is essential for self-support. 

One of the most important ailments among 
school children is defective vision. Medical in- 
spection has revealed the fact that at least 25 per 
cent, of the pupils have eye troubles which fur- 
nish a fruitful source of retardation in learning 
and which in most instances are easily remedied. 
The adjustment of proper glasses will, in the 
majority of cases, permit these children to resume 
their places in the classroom with the normal 
child. 

Good hearing is also a very important asset to 
the child, and especially so during the period of 
schooling. Defective hearing may often follow 
the infectious diseases which are common among 
children of school age and such a deficiency 
should be corrected as early as possible. 

Mouth breathing indicates an abnormal con- 
dition of the nose and throat. Obstructive aden- 
oids and tonsils predispose to infectious diseases 
and should therefore receive immediate attention. 
They also cause mental dulness. 

The supervision and correction of the condi- 
tion of the teeth of the child are of extreme im- 
portance. Arranging a proper diet for the school 
child is a problem in itself, but the time consumed 



230 Care of School Children 

in studying such a problem is wasted if the child 
has defective teeth. 

At the beginning of the school year the 
medical inspectors in all the large cities make a 
thorough examination of all public school chil- 
dren. Those who have physical defects are 
recommended to their family physician for treat- 
ment, while those who cannot afford to pay for 
medical attention are referred to hospital dispen- 
saries or to the free dental and eye dispensaries. 



The Care of School Children 

f^ HILDREN should not be permitted to go to 
school without an adequate breakfast. A 
large percentage of them are often sent to school 
without a morning meal. It is impossible for 
them to be good scholars if they are not properly 
fed, nor can they have sufficient physical vigor to 
resist disease unless they are given sufficient and 
selected foods given at regular meal hours. 

The short period immediately after school 
hours should be spent outdoors in play. They 
should never be allowed to play in the streets 
because of the danger of vehicles. Playgrounds 
are generally established for this purpose. Chil- 



Care of School Children 231 

dren should be indoors after dark except during 
the warm and mild weather. The school lessons 
may be prepared before or just after the evening 
meal. 

The eyes of the school child need special at- 
tention. If the eyes are inflamed, red or watery 
or ar-e crossed, they need the attention of an 
oculist. In many cities the Board of Education 
provides medical inspectors to look after the wel- 
fare of the children. If parents should receive a 
note from the school doctor about the child's eyes 
or about any other condition of the body, it is 
essential that this matter be attended to at once. 
(Seepage 253). 

The ears should be cleaned out at each face 
washing with the end of the wash rag. Running 
ears are diseased ears and call for immediate at- 
tention. Do not expect them to stop running as 
the child grows older. Deafness of a serious na- 
ture may result from neglect. Children should 
not place shoe buttons, cotton, match sticks, 
beans and other foreign bodies in ears. 

Children suffering from running nose or 
defective breathing, should have a care- 
ful examination of the nose and throat for ob- 
structions. 

The mouth should be rinsed thoroughly each 
morning with water. (See page 258). 



2Z2 Care of School Children 

Head lice are not uncommon among school 
children and their presence is indicative of lack 
of cleanliness. The head should be washed with 
hot water and soap at least once a week. Clean- 
liness keeps away all body lice. The best time to 
wash the head is before bedtime. The hair should 
be thoroughly combed and dried before retiring. 
If head lice should be found, they are best de- 
stroyed by clipping the hair in the case of boys 
and washing the scalp thoroughly and applying 
to the scalp tincture of larkspur or vinegar. In 
the case of girls the treatment is more prolonged. 
The head should be thoroughly washed and then 
hot vinegar applied. The hair is wrapped in a 
towel overnight and the next morning thoroughly 
combed with a fine tooth comb to remove the eggs 
of the lice. 

Skin rashes should always be taken care of 
by the family physician. 

Every school child should bathe twice 
weekly. Cleanliness of the skin is essential in 
order that it may be healthy, free from dirt and 
be enabled to properly perform its function. 
Bathing is best at bedtime. The water should be 
warm, followed by a cold water sponge. 

The hands should always he washed be- 
fore eating. Dirty hands carry disease germs 
to the mouth and infect the entire body. Every 



Care of School Children 233 

school child should have a clean face, neck, ears, 
hands, and hair combed on entering school both 
for the morning and afternoon period. 

Children should be protected from exposure 
to wet by proper shoes and overshoes and outer 
garments. A child who is required to remain in 
the classroom with wet stockings and shoes may 
become chilled and later become ill. The wet 
shoes and stockings should be changed im- 
mediately when reaching home. 

The child's clothing should be of light 
weight and warm. Especially for winter the gar- 
ments should be wool and cotton mixed. Pure 
wool shrinks. Plain cotton does not absorb the 
sweat as readily as wool and may chill the body. 
Plain cotton is more advisable for summer in 
that it tends to keep the body cool. 

The outer garments should vary according to 
the outside temperature and the clemency of the 
weather. 

A sweater underneath a coat gives comfort 
and warmth. Warm underclothing, a sweater 
and coat, cotton wool pants, medium weight stock- 
ings and a suitable cap are sufBcient for most 
Iboys. 

Girls can wear washable dresses of different 
w^igtits throughout the year, if suitable under- 
wear h worn. 



234 Diet for the School Child 

Mufflers and scarfs worn outdoors should 
always be removed indoors. 

The shoes worn by children should be given 
careful attention and selection. Tight shoes 
should not be used nor should badly shaped shoes 
with worn heels and soles. Corns, bunions, flat 
feet, and other foot disorders in adults may be 
traced to illfitting shoes during school life. Chil- 
dren should learn to keep the shoes firmly laced 
and always polished. 



Diet for the School Child* 

GOOD FOOD HABITS 

nr^HE child is the adult of tomorrow. The 
kind of food a child has today determines 
to a considerable extent the fitness of the future 
citizen. Those who direct the feeding of the 
child have a responsibility which can not be over- 
looked. Good food habits should start today. 
Tomorrow may be too late. 

I. Meals should he given at regular times. — 
There should be regularly appointed hours for 
eating. Do not allow children to eat except at 



* Courtesy of Bureau of Education, Department of the In- 
terior, and Child Health Organization of America. 



Diet for the School Child 235 

these hours unless ordered by a physician. If 
the child gets very hungry two or three hours 
before time for the next meal, give him a slice of 
bread and butter. Do not give a child candy, 
fruit, nuts, cake, and cookies between meals. 

2. Plenty of water should be given. — Children 
as well as adults should drink plenty of water 
between meals. Water will often satisfy the 
craving which many mistake for hunger. Food 
should not be washed down with water during 
meals. 

3. Children often have to be taught to like 
things which are good for them, — Be patient, 
but firm, in teaching a child to like new foods. 
Begin by giving a small amount of new food; 
give but one new food at a time, and repeat it 
regularly until the child learns to like it. 

4. Children should not be forced to eat when 
not hungry. — Forced feeding causes more harm 
than light eating for a few days. If the appetite 
does not return, consult a physician. 

5. They shoidd be happy while eating. — Let 
the mealtime be a joyous occasion, without undue 
excitement just before, during, or after eating. 

6. Plenty of time should be allozved for meals, 
— Insist on thorough chewing so that the stom- 
ach may not be overtaxed. 



236 Diet for the School Child 

7. Dirt is dangerous, — Children should have 
clean hands and faces while eating; they should 
sit down to a clean table and eat in an orderly 
manner. Flies should not be allowed to alight 
on the food either before or during meal time. 

THE child's food 

A child should not be allowed to make his 
entire meal from one or two articles; he needs a 
variety of foods to supply all kinds of growing 
material. He can not develop normally unless 
he has this variety. Every day the diet of the 
child should contain some of each of the following 
types of foods: 

I. Milk, which is the best and most important 
food for growing children. No other food can 
take its place. Children over 5 years of age 
should have at least three cups a day, and more 
where possible. Milk should not be given very 
cold." Warm milk is more easily digested. Often- 
times milk can be taken warm when it causes 
distress if taken cold. If children rebel against 
drinking milk alone, it may be given in the form 
of cocoa, milk soups, custards, etc. Where it is 
impossible to get fresh milk, dried milk or evap- 
orated milk may be used. If dried skimmed milk 
is given, give the child plenty of vegetables and, 
if possible, some cream or butter. Tea and 



Diet for the School Child 237 

coffee should not he given to growing children 
at all. 

2. Eggs, fish, fowl, or meat, or their equiva- 
lents, — Where plenty of milk and an tgg a day 
are included in the diet of the child, very little 
meat need be given before the seventh year. 
Allow not more than 2 ounces of meat daily for a 
child from 7 to 10 years; 3 ounces daily from 10 
to 14 years. The broth from stews may be given 
on vegetables and bread. Where meat and eggs 
can not be purchased because of cost and scarcity, 
the diet should contain a quart of milk, with pea 
or bean soups, spinach and other green vege- 
tables, oatmeal, and dried fruits. Vegetables and 
fruits are also excellent sources of iron and other 
elements necessary for growth, and, combined 
with milk, will supply food value more than equal 
to meat. 

3. Bread, cereals, and other grain products. 
— These should furnish at least one-third of the 
food required by the child. The most nourishing 
ones should be included in the diet; cereals and 
flours with some of the outside of the grain are 
more nourishing than the refined flours. Hence, 
entire wheat flour and brown rice are better than 
white flour and white rice. They also help to 
prevent constipation. The following list gives 
the cereals and flours in the order of the amount 



238 Diet for the School Child 

of nourishment which they contain, and their 
rating, based upon the proportion of the chief 
elements in the food which are necessary for 
growth : 

Food Units. 

Oatmeal 2,500 

Force 2,300 

Shredded wheat 2,200 

Graham flour 2,200 

Barley 1,450 

Rye flour 1,450 

Cornmeal 1,350 

Macaroni 1,350 

Cream of wheat 1,350 

Farina 1,350 

White wheat flour 1,250 

Hominy 1,150 

Rice (white) 1,150 

Corn flakes 1,100 

To reduce this to a cost basis, divide the rat- 
ing given above by the cost per pound and com- 
pare the food value with the money spent. Oat- 
meal at 8 cents a pound gives 310 food units for 
every cent spent. Hominy at 7 cents a pound 
gives 164 food units for every cent spent. Then, 
oatmeal is much more economical than hominy. 
For older children (over 10 years) cereals and 
breads may be varied and the food value increased 
by the addition of dried fruits. 

Dates at 25 cents a pound are cheaper than 
fresh apples at 5 cents a pound and make a valu- 
able addition to cooked cereal. (To prepare dates, 



Diet for the School Child 239 

wash, chop in small pieces, and stir into any 
cereal. ) Stewed prunes may be used in the same 
way. They are especially good with hominy and 
other white cereals. Mixed cereals offer a great 
variety of flavors. Two or three kinds may be 
cooked together. 

Cereals should be thoroughly cooked. If 
children do not like them, it is usually because 
they have not been properly cooked and served. 
They need long, slow cooking over boiling water 
or in a fireless cooker. The cereal may be cooked 
the night before, and reheated in the morning in 
a double boiler, or by setting the dish in a pan 
of hot water. 

Directions for cooking cereals: Stir the 
cereal into the right amount of boiling salted 
water, and cook over direct heat until the cereal 
thickens, stirring constantly. Then set into boil- 
ing water or the fireless cooker and cook as long 
as directed without further stirring; proportions 
are as follows: 

1 cup of cornmeal, 6 cups water, 1 to 2 teaspoonf uls salt ; cook 
3 hours. 

1 cup wheat preparations, 4 to 6 cups water, 1 to 2 teaspoon- 
fuls salt; cook 1 hour. 

1 cup hominy, 4 cups water, 1 teaspoonful salt; cook 3 hours. 

1 cup rolled oats, 2 to 2^ cups water, one-half teaspoonful 
salt; cook 2 to 3 hours. 



240 Diet for the School Child 

Uncooked or ''dry'' cereals may be given oc- 
casionally, if cost can be disregarded, and with 
milk and fruit make an agreeable supper dish. It 
should be remembered that it takes two or three 
times as much of these dry cereals by volume to 
supply the same amount of food as of cooked 
cereal. 

Cereals should be served with milk and not 
more than one teaspoonful of sugar to a saucer- 
ful of cereal. For those who take them well 
without sugar it may be omitted altogether. 

Flours and cereals may be made into bread, 
puddings, soups, cookies, etc. 

4. Vegetables form a very essential part of 
the diet. They are especially necessary if milk 
is lacking. There is little danger of eating too 
much of the right kind of vegetables in a well- 
balanced diet. They are very important in help- 
ing to guard against constipation. Oftentimes 
hunger is due to the absence of vegetables in the 
meals, and children who crave more food find 
their appetite satisfied where vegetables are given 
regularly. They give volume or bulk to the food. 
Potatoes, baked, boiled, or mashed, should be 
given practically every day. They are economical 
even at 5 cents a pound. Other valuable vege- 
tables are dried and fresh peas and beans, spin- 
ach, onions, string beans, squash, cauliflower, 



Diet for the School Child 241 

asparagus, carrots, stewed celery, and for older 
children parsnips, oyster plant, and turnips; and 
in summer all kinds of *'pot greens" such as beet 
tops, turnip tops, dandelions, chard, and cooked 
lettuce. 

Dried and canned vegetables if of good 
quality may also be given in winter. Almost all 
vegetables except cabbage, cucumbers, and corn 
may be used freely after the fifth year; corn 
should not be given before the twelfth year. In 
soups and stews more vegetables and less meat 
should be used than is common practice. Meat 
should be used chiefly for flavoring. 

Much valuable food material dissolves in the 
water in which vegetables are cooked. This 
decreases their value as food. So far as possible 
this water should be used in the making of meat 
gravies and soups. Vegetables should be cooked 
only long enough to become tender. 

5. Fruit. — There should be some fruit in the 
diet every day. Where fresh fruit is not possible, 
use dried fruit. Fresh fruit should be given only 
in season ; it should be very ripe, but not decom- 
posed. Bananas are not ripe until the skins have 
brown spots. If served before this stage, they 
should be baked or boiled. They should not be 
given raw before the tenth year. Jams and 
preserves should be avoided. 



242 Diet for the School Child 

6. Sweets. — There is great danger of children 
getting too much sugar and spoihng the appetite 
and the digestion. Children should not have, all 
told, more than the following amounts: 

5 to 7 years 1 tablespoonf ul daily. 

7 to 12 years 2 tablespoonf uls daily. 

Sugar is less likely to be harmful when taken 
in cocoa, rice, or other simple puddings, custards, 
or in dried fruits, fresh fruits, and vegetables. 
Molasses has a higher food value than sugar. 
Its larger use should be encouraged. Whatever 
sweets are given should be at the end of a meal ; 
never between meals or at the beginning of a 
meal. They spoil the appetite for other necessary 
food. 

7. Fat is essential for growing children. 
Milk fat (cream and butter) is the most impor- 
tant kind. Children should, if possible, have un- 
skimmed milk. If the cream is removed from 
their milk, they should have plenty of butter. If 
they have unskimmed milk, butter substitutes such 
as nut butter or oleomargarine may be used. 
Vegetable oils may be given to increase the energy 
of growing children; corn, olive, cottonseed, and 
peanut oils are all good. Fat is more easily 
digested uncooked. Children should not have 
cooked fat except bacon. All fried foods should 
be avoided. 



Diet for the School Child 243 

PLANNING THE MEALS 

The meals of a school child should be planned 
to give enough variety and provide all the grow- 
ing material needed. The following suggestions 
will help to provide well-balanced meals for school 
children. 

I. Breakfast should contain milk, bread and 
butter, and when possible, in addition, cereal, 
fruit, or tgg. 

Milk. — Part may be eaten on a cereal, the 
rest drunk plain or with cocoa. 

Bread should be stale or toasted (whole 
wheat, oatmeal, corn meal, rye, barley, or white 
bread or any other simple bread). 

Butter may be oleomargarine, nut margarine, 
or some other butter substitute provided the 
cream has not been removed from the milk which 
the children use. If the cream has been removed 
either for food or drink, butter and nut butter 
substitutes must be given freely. 

Cereal. — The best are oatmeal, wheatena, 
petti John, corn meal, samp, hominy, rice, farina, 
cream of wheat. 

Fruit may be orange, stewed or fresh apple, 
ripe pear or peach, thoroughly ripe or cooked 
banana, stewed dried fruit, such as dates, figs, 
prunes, apples, or peaches. 



244 Diet for the School Child 

The fresh fruits in season are to be preferred 
where it is possible to obtain them; they are us- 
ually expensive, however, and one often gets 
much better return for the money in dried fruit. 
All fruits except orange should be cooked for 
children under 7 years old. 

Eggs may be given soft boiled, poached, 
scrambled (plain or in milk) and omelet. Fried 
eggs should not be given. 

II. Dinner^ or the heaviest meal, should pre- 
ferably be in the middle of the day. This is not 
feasible when the child must hurry home from 
school, eat rapidly and rush back; nor when the 
child must carry his lunch to school; nor when 
the mother can prepare but one dinner a day and 
the father must have his at night. For a light 
midday meal, give a vegetable soup, bread and 
butter, a simple dessert or the meals hereafter 
indicated for supper. 

An ideal dinner should consist of soup, meat 
or eggs, vegetables, bread and butter and dessert. 

Clear meat soups or broths have very little 
nourishment. Soups for children should be made 
from dried peas or beans, or with fresh vege- 
tables, such as potato, spinach, carrots, peas and 
onions; such soups with the addition of rice or 
barley and a small amount of milk make a very 
nourishing dish, 



Diet for the School Child 245 

Meat should be given but once a day, and the 
quantity should not be large. Lean beef, mutton, 
lamb, chicken, and such fish as cod, haddock, and 
halibut, but not salt or dried fish. As a rule cold 
meat should be avoided by young children be- 
cause it is rarely chewed properly. 

Vegetables should form a large part of the 
diet, especially in summer. A list of those avail- 
able has already been given. 

Bread and butter should always be given. 

Dessert. — With plenty of bread and butter 
and vegetables, dessert is not essential. When 
given it should always be plain and simple. The 
most wholesome desserts are cereal puddings 
with fruit, such as rice, oatmeal, baked Indian or 
bread pudding or plain cookies, or cake and cocoa 
or fruit custards, junkets, ice cream or ices, 
stewed dry or fresh fruit, sliced orange or sweet 
chocolate. 

Suggested dinner combinations are given in 
later pages. 

III. Supper. — The supper, when the hearty 
meal is given at midday, should be a simpler meal. 
Give dishes made of milk, eggs, strained vege- 
tables, cereals, and fruit, rather than meat, whole 
vegetables, and sweet desserts. 

Some suggestions for supper are as follows: 

Bread and milk, baked potato, stewed fruit. 



246 Diet for the School Child 

Cereal and milk, bread and butter, baked 
banana. 

Poached egg on toast, baked potato, bread 
and butter, apple sauce, and gingerbread. 

IV. Basket or School Luncheon. — The 
child needs at least three good meals a day. If 
he has to carry a luncheon to school, it should be 
a substantial one, which will give him nourish- 
ment enough to keep him from getting exhausted 
during the afternoon. The hot midday meal is to 
be preferred; but it is better to carry a well- 
balanced luncheon than to hurry home, bolt half 
the dinner for fear of being late, and get ex- 
hausted before the end of the day. It is desirable 
to have hot soup or cocoa at school; it is then 
easy to supplement this. If, however, he must 
carry the whole luncheon, it must be a nutritious 
as well as an appetizing one. 

Suggestions for a basket luncheon : The most 
feasible are sandwiches, dessert, fruit, and a 
bottle of milk. 

For sandwiches use the most nourishing kinds 
of bread, such as whole wheat, oatmeal, brown, 
raisin, or nut bread. Appetizing fillings may be 
egg, chopped meat, fresh cottage cheese plain or 
combined with dried fruit, sliced tomatoes, chop- 
ped vegetables such as beets or lettuce and jelly, 
or peanut butter and chopped raisins or dates. 



Diet for the School Child 247 

Where possible, a baked custard adds variety. 

If fruit is not included in the filling, a small 
glass jar of some stewed fruit or apple sauce may 
be added, or some fresh ripe fruit, or a few dates. 

For dessert plain cookies, ginger cookies, or 
these with cheese, date cookies, sponge cake, 
gingerbread, or sweet chocolate. It is easy to 
get a small jar with a tight screw top for sauce, 
puddings, and custards and to get a bottle for 
carrying milk. 



248 



Diet for the School Child 



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Trivial Complaints Among Children 

/^HILDREN usually react promptly to the 
invasion of infectious disease. The early 
symptoms of restlessness, irritability, loss of ap- 
petite and disinclination to play should be the 
warning signs that the child is not feeling well. 
Parents will too often look at trivial signs with 
indifference, with the belief that the usual home 
remedies may clear up the prevailing symptoms. 
On the contrary, every case of sore throat, run- 
ning nose, digestive disorder, or rise of tempera- 
ture among children should be looked upon as 
suspicious of one of the infectious diseases. If 
the sick child is of school age, he should be re- 
tained at home and not allowed to mingle with 
other children. 

It is during the first few days of illness that 
infection is carried from one child to another in 
the school room. The slightest ailments among 
children should therefore be considered as indica- 
tions of a more serious condition until proved 
otherwise. The school medical inspectors of the 
Health Department in large cities make a routine 
examination of the children and send home those 
who are suffering from symptoms suspicious of 
infectious disease. 

(251) 



252 Trivial Complaints Among Children 

Parents, however, can be of valuable assist- 
ance to the health authorities by sending for the 
family physician at the onset of trivial complaints, 
when early treatment may abort a more serious 
disease and when prompt isolation at home will 
prevent the spread of infection toothers. 

More especially is it important to give ade- 
quate attention to trivial complaints among chil- 
dren in the Spring and Fall when diphtheria, 
whooping cough, scarlet fever and respiratory 
diseases are quite prevalent. All of these dis- 
eases are preceded or ushered in either by sore 
throat, cold in the head, cough, or by digestive 
disturbances. No time should therefore be lost in 
placing the child under medical care. Home 
remedies may prove valuable in preparation of 
the child for further treatment but should not be 
relied upon if symptoms fail to abate and are 
getting worse. 

One of the most difficult problems with which 
the health departments are confronted, is the 
control of whooping cough. Although most 
health departments place such cases under quar- 
antine and placard the home, parents will some- 
times allow convalescing children to leave the 
home, to attend moving picture shows and to ride 
in the street cars. While this disease is not very 
infectious during convalescence, still the free 



Defective Vision in School Children 253 

mingling of such children with the healthy ones 
is a serious menace to public health. It would be 
impracticable for the health authorities to keep 
constant watch on these cases and, therefore, co- 
operation of the public must be relied upon to 
enforce the quarantine law. Many families fail 
to have medical attention for children affected 
with this disease because it is erroneously believed 
to be a trivial affection. Statistics, however, 
show over 6,000 children die in the United States 
annually from this cause. Trivial complaints 
therefore become serious ones when neglect and 
indifference are allowed to take precedence. 



Defective Vision Among School 
Children 

/^ORRECT vision is most essential for the 
progress of the child during the school 
period, and yet statistics show that at least one- 
fourth of the school children have defective vision 
or eye strain of such gravity as to require the 
attention of an oculist. Among the various 
physical defects which the school medical inspec- 
tor meets, defective vision is one of the most fre- 
quent and most serious, and in many instances 



254 Defective Vision in School Children 

this can be readily corrected by the adjustment 
of glasses. 

The most frequent cause of eye strain is far- 
sightedness, but a large number of school chil- 
dren are affected with nearsightedness. Cross- 
eye is not infrequent, and the parents of children 
who are affected with such a condition should not 
consider it lightly or believe that this defect will 
right itself as the child grows older. It is un- 
reasonable to expect children who cannot see the 
blackboard or read their books to keep up with 
their studies as the normal child does. 

It is known that only a few children with eye 
troubles continue their schooling after the age of 
fourteen. The large number of delinquencies 
caused by eye defects indicate the need of ex- 
amination , of the vision of children during the 
early school period, in the kindergarten and first 
grade, when a correction of these defects will 
eliminate difficulties later. 

The education of each school child costs ap- 
proximately $50 per year, and since each child 
remains at school until fourteen years of age, the 
total cost for the entire school period amounts to 
$400. If by reason of defective vision the child at 
fourteen years of age should only reach the fourth 
grade instead of the eighth, then the State or 
city has expended $400 and only received $200 



Conservation of Vision 255 

worth in value; but the loss to the child is still 
greater because at this age he seeks employment 
and the defect which has hindered him in his 
school work will also be a handicap in his efforts 
to support himself. The insufficient education 
which he received will further hamper his prog- 
ress as a citizen. 

To prevent this loss to the State and to the 
child, a pair of properly adjusted glasses will, in 
most cases, cause the delinquent child to catch up 
rapidly in his school studies and assume the same 
position with the normal child. For this purpose 
many health departments maintain free eye clinics 
for the children of parents unable to pay for 
medical services. 



Conservation of Vision 

PREVENTIVE medicine has opened the way 
to endless fields of investigation which have 
as their basis the prevention of disease and the 
promotion of the public health. It is only of 
recent date that attention has been paid to the all 
important subject of conserving the eyesight. 
Routine inspection by the health authorities has 
done much toward the conservation of vision 
among children of school age, but after leaving 



256 Conservation of Vision 

school such supervision reverts to the individual 
when there is a tendency to overlook defects 
which do not entirely incapacitate one for work. 

Employers, however, have recognized the im- 
portance of rendering the surroundings of the 
office and workshop free from those factors which 
may be detrimental to the eyesight. Modern 
structures with abundant window space are evi- 
dences of the recognition of the usefulness of 
daylight and its preference to artificial means of 
illumination from the standpoint of the health of 
the eyes. 

The frequency with which persons complain 
of eye strain is indicative of the fact that faulty 
illumination may play an important part in ser- 
ious defects of vision. The increasing population 
of indoor workers has therefore made the prob- 
lem of lighting offices and workshops a very im- 
portant one. While health officials are not gen- 
erally in a position to express an expert opinion 
as to the details of lighting systems, a few hints 
from the standpoint of the health of the workers 
may serve as a guide to lighting engineers. 

Daylight is the best lighting system. 

Window space should be one square foot to 
every five square feet of floor space. 

The desk or work should be so placed that the 
light falls over the left shoulder of the worker. 



Conservation of Vision 257 

^^A-:t'^cial illumination should approach the 
diffuseu daylight. The intensity should vary with 
the kind of work and its distance from the object 
to be illuminated. 

Direct illumination should be preferred for 
near work where precise vision is required. Such 
lights however should be constant and without 
glare and should be so arranged as not to reflect 
rays of light into the eyes of the worker. 

Persons working in foundries and places 
where the light is intense from molten metals 
should guard the eyes by properly prescribed 
colored lenses. 

The color of the room has also an important 
bearing upon illumination. The walls should be 
of a light color preferably pale green or buff. 
Surfaces, however, should not be glazed to avoid 
uncomfortable reflections. 

Persons engaged in doing such work as sew- 
ing, painting, drawing and engraving should take 
advantage of the daylight. 

More detail attention to lighting systems in 
offices and workshops would materially lessen the 
number of cases of defective vision and assist in 
preserving the most valuable of special senses. 



17 



Good Teeth Essential to Good 
Health 

nr^HE mouth is not only the gateway of the aH- 
mentary tract but the portal of entrance for 
many diseases. The teeth are the sentinels on 
watch which prepare the food for further diges- 
tion. Decayed teeth cannot perform their proper 
function but act as hiding places and incubators 
for disease germs which multiply rapidly and 
distribute their poisonous products through the 
body. The natural shape and position of the 
teeth form crevices or pockets which favor the 
retention of small particles of food. These may 
remain in the mouth for a long time and finally 
become decomposed, imparting an unpleasant 
odor to the breath and favoring the production 
of acid products which bring about decay of the 
teeth. 

The mouth is the hot-bed for many germs 
that are taken in accidentally with the food and 
by the fingers or eating utensils. Among the 
many diseases which may gain entrance through 
the mouth are tuberculosis, typhoid fever, pneu- 
monia, diphtheria, epidemic sore throat and 
others. Hence it is necessary to keep the mouth 
in a hygienic condition from the cradle to the 
grave, and at the appearance of the baby's first 

(258) 



n 



Good Teeth Are Essential 259 

tooth, measures should be taken to care for the 
teeth. 

Adults should have their teeth inspected at 
least twice a year by a dentist, in order that the 
defects may be detected early and corrected be- 
fore any serious damage has been done. It should 
be remembered that one infected tooth is like a 
rotten apple in a barrel that is apt to involve the 
others. There is nothing more repugnant about 
one's personal appearance than the sight of ugly, 
dirty, decayed and foul smelling teeth. They 
reflect not only upon the personal cleanliness of 
the individual, but are the external evidences 
which indicate poor digestion and poor health. 

The poisons absorbed from the pus laden 
gums act jointly with the acid producing germs 
of putrefaction in bringing about a condition of 
malnutrition. The food is not properly masti- 
cated and is often swallowed whole, placing the 
burden of digestion entirely upon the stomach. 
These factors all act in harmony in reducing the 
state of health and the resistance to disease. It 
is better for the aged to secure a set of false teeth 
than endure the injurious effects of a few decayed 
teeth which are not performing any valuable 
function. 

The teeth should be brushed at least once 
daily with a firm bristle brush. More important 



260 Tonsils and Adenoids 

than the sideway motion of the brush is the up 
and down movement to reach all the crevices 
between the teeth. 

The fact to be emphasized is that the preser- 
vation of the teeth is essential to the maintenance 
of good health. 



Tonsils and Adenoids 

/^ NE of the most frequent ailments of the 
school child, which gives the school medical 
inspectors much concern, is obstructed breathing, 
caused by diseased tonsils and adenoids. The 
growing child must receive an adequate allowance 
of fresh air to insure its proper development and 
any diseased condition of the nose and throat 
which may interfere with this supply is a hinder- 
ance to its good health. Yet there is a large 
number of school children who are so affected 
and are found to have enlarged tonsils and aden- 
oids when examined by the school doctors. These 
abnormal conditions not only reduce the health 
of the children, but also handicap them in their 
educational progress. 

Interference with normal respiration may ulti- 
mately result in such physical defects as stoop 
shoulders, flat chest and a dull facial expression 



Tonsils and Adenoids 261 

caused by mouth breathing. Nervous disorders 
such as headache, restlessness at night, habit 
spasms and depressed mental activity may, in 
many instances, be traced to obstructing growths 
in the upper air passages. Defective speech is 
also a common symptom. Enlarged tonsils and 
adenoids furnish suitable breeding places for dis- 
ease germs and thus predispose to such infections 
as diphtheria, scarlet fever, influenza, meningitis, 
pneumonia and tuberculosis. Rheumatism and 
heart disease owe their origin in a great many 
instances to infection through the tonsils. They 
are also the gateway of infection with tuberculosis 
of the lungs, there being a direct communication 
between these organs. Tubercular glands and 
cold abscesses of the neck are quite often traced 
to diseased tonsils as their cause. 

Earache in children is not infrequently the 
result of enlarged tonsils and adenoids. When 
inflamed, the pus which forms is drained into the 
throat and swallowed, giving rise to symptoms 
of poisoning of the whole body. Constant ab- 
sorption of such poisonous products causes in- 
digestion, poor nutrition and a lowered state of 
health. 

Thus it is seen that many conditions may 
result from enlarged tonsils and adenoids and 
the sooner these diseased organs are removed, 



262 Conservation of Hearing 

the earlier will the child be relieved of a constant 
source of sickness and impaired health. Delay 
may lead to serious permanent defects, depriving 
the child of the opportunity to make its normal 
progress. 

Parents of school children who are troubled 
with any obstruction or disease process of the 
nose and throat are notified of the fact by the 
school medical inspectors. Persons who re- 
ceive such notices should give them their im- 
mediate attention and consult their family physi- 
cian with the view of having them corrected. 
The hospital dispensaries are always ready to 
administer the necessary treatment or perform 
needed operations for the children of parents who 
cannot pay for the service of a private physician. 



Conservation of Hearing 

/^ NE of the most frequent complications of 
respiratory diseases is inflammation of the 
organ of hearing. While this condition may ap- 
pear trivial at first, it may subsequently lead to 
very serious impairment of the hearing. This is 
especially true among children who are often 
troubled with sore ears following illness with the 
common childhood diseases. Many cases of de- 



Conservation of Hearing 263 

fective hearing or deafness in the aduh may be 
traced to lack of care or inattention to ear troubles 
during the school age. The school medical in- 
spectors are continually notifying parents of chil- 
dren who need attention to their ears. Failure on 
the part of parents to heed this notice makes 
them guilty of gross negligence since delay may 
mean a permanent loss of hearing to the child 
and seriously handicap its progress in school. 

Good hearing ranks with good vision as an 
important asset to the growing child. We can 
all appreciate the disadvantages of defective 
hearing in adults who are barred from various 
occupations because of their physical defect. We 
are also aware of dangers to which they are ex- 
posed from moving vehicles and from failure to 
hear warning gongs and whistles. Knowing 
these various drawbacks parents should exert 
every effort to protect and safeguard the hearing 
of their children. 

Enlarged tonsils, adenoids, sore throat, de- 
cayed teeth and the various febrile diseases of 
childhood are frequent causes of ear troubles. 
Children often place foreign bodies in the ears, 
such as peas, beans, shoe buttons, cotton and 
many other substances. These should be removed 
immediately lest they be the cause of further 
trouble. 



264 Conservation of Hearing 

Do not permit children to pick the ears with 
tooth picks, hairpins, pencils, matches or any 
other object because of the serious injury which 
may result. If the child is constantly picking at 
the ears, there is probably something wrong with 
them. 

Running ears in children is always a serious 
condition as the health of the child is constantly 
undermined by the absorption of poison from the 
diseased organs. Parents should not expect this 
condition to get well of its own accord. On the 
contrary, ears which are discharging foul smell- 
ing pus may even be a source of danger to the 
life of the child since the diseased condition may 
spread and cause what is known as mastoid dis- 
ease or brain abscess. 

Parents are cautioned against "boxing" or 
pulling the ears of children as a form of punish- 
ment. The organ of hearing is very sensitive 
and resents even slight injuries. 

Harm may also result from violent and 
forcible blowing of the nose as infectious material 
may reach the interior of the ear from this prac- 
tice and bring about an inflammatory process. 
Always blow the nose gently, one nostril at a 
time. 

Consult your family physician if the child 
complains of earache or if its hearing is impaired. 



PART VII 



First Aid to the Injured 

T"^ HE primary thought in rendering first aid 
to the injured should be to apply such meas- 
ures of treatment which will sustain the patient 
until the doctor arrives. The person applying 
first aid measures should keep in mind that he is 
not taking the place of the doctor but is merely 
acting as a temporary nurse, making the injured 
patient as comfortable as possible or applying 
such treatment that will prevent any further com- 
plication. 

The only medicines which are actually needed 
in first aid are aromatic spirits of ammonia and 
tincture of iodine, the former taken internally in 
water while the latter, which is a poison, is ap- 
plied only externally. All other medications 
should be left to the discretion of a physician. 

Aromatic spirits of ammonia may be admin- 
istered to adults w^ho have fainted and to those 
who feel very weak from sickness or exhaustion, 
or following an injury. Never attempt to give 

(265) 



266 First Aid to the Injured 

anything by mouth to a person who is uncon- 
scious. 

Tincture of iodine may be used for cuts and 
bruises on the skin and for sprains. The purpose 
of using it on open cuts is to kill the germs which 
may have already entered the injured part and 
those which may exist naturally on the skin sur- 
rounding it. If the germs are not killed they may 
enter the blood or lymphatics through the cut 
surface and cause blood poisoning or infection 
with pus formation at the site of the wound. 
After such treatment, waiting sufficient time for 
the iodine solution to evaporate, the injured part 
is protected from outside dirt by covering with a 
sterilized bandage. 

A sterilized bandage is a roll of gauze which 
has been subjected to a high temperature suffi- 
cient to kill all bacteria which may be upon it. 
No bandage is sterilized unless it is contained in 
a dust proof wrapper, most common of which is 
paper. 

No attempt is made in this article to ex- 
plain the first aid treatment of severe injuries 
except that such patients should be placed in a 
comfortable position until medical aid is secured. 
In the absence of such aid it is better not to touch 
the injured part except to place it in position of 
least pain and to protect it from outside dirt by a 



First Aid to the Injured 267 

freshly laundered sheet or towel. It is best to 
give all attention to the individual rather than 
to his injury by placing him flat on his back 
giving suitable support to the head. 

Never try to wash wounds or to remove im- 
bedded dirt. It is better to wait until it is done 
with the clean hands of the surgeon. Dirty hands 
carry disease germs and no hands are clean un- 
less they are surgically clean, which means proper 
scrubbing and disinfection by chemical solution. 

Ordinary bruises in which the skin is not cut 
may wait until the physician is consulted. 

Sprains may be treated temporarily by band- 
aging tightly with a firm roller bandage. If one 
of the ankles is affected, the patient should be 
carried or conveyed to his home. Don't continue 
to treat a sprain yourself. Ofttimes it may be 
associated with a break of the bones. 

Fractures which are commonly known as 
broken bones, should never be treated by other 
than a doctor. The first aid treatment consists 
merely of placing the part in a comfortable posi- 
tion with pillows, blankets or any wearing apparel 
beneath it and on either side to prevent it from 
excessive movement. The use of splints is for- 
bidden even for first aid unless it is rendered by 
a nurse or person competent and quite familiar 
with their application. 



268 First Aid to the Injured 

Burns require special form of treatment. The 
only remedy advised for first aid is to apply white 
vaseline. Severe burns should not be touched 
except by a physician. 

''Something in the eye" spoken of as a foreign 
body should never be removed by a layman, un- 
less that foreign body is on the under surface of 
the lids where it may be removed with the corner 
of a clean handkerchief. Never use match sticks 
or tooth picks. Do not attempt to remove any- 
thing on the "sight" of the eye because you will 
cause more harm than good. Such foreign 
bodies should always be treated by an oculist. 
Small injuries to the eye may result in extensive 
loss of vision. Don't meddle with the eye. 

Fainting and nose bleed are best treated by 
placing the patient on his back with the head low 
without a pillow or any support. 

First aid to the drowning. (See page lOO.) 

Heat exhaustion and heat prostration. (See 
page 97.) 



INDEX 



Accidents, industrial, 153 
Adenoids and tonsils, 260 
Air, fresh, a germicide, 133 
Animals, diseases transmitted 
by, 187 

Babies, blindness among, 219 
care of during cold weather, 

223 
care of during hot weather, 

221 
Barber shops, sanitary, 170 
Bathers and boating parties, 99 
Bedbug as a carrier of disease, 

87 
Birth registration, 217 
Blindness among babies, 219 

Cancer a curable disease, 159 
Carriers of disease, typhoid, 
2 
bedbug, 87 
Cerebrospinal meningitis, 51 
Chicken pox, 39 
Child, care of pre-school, 225 
Children, preparing for school, 
227 
school, care of, 230 
defective vision, 253 
diet for, 234 
trivial complaints, 251 
Christmas, health hints for, 112 
Clean Up Week, 185 



Clothing, proper, winter, 165 
Coal-gas, detrimental, 142 
Colds, coughs, pneumonia, 53 
Cost of heating home, 139 
of preventable disease, 66 

Deformities, prevention of, 119 
Diet for school children, 234 
Diphtheria, can be cured, 26 

immune against, 30 
Disease associated with the 
soil, 93 

carrier, the bedbug, 87 

occupation and, 151 

transmitted by animals, 187 
Disinfectants, 178 
"Dog days," 102 
Don'ts for the Fourth, 110 
Don't catch the grippe, 22 
Drinking cups, common, 180 
Drowning, first aid, 99 
Dust nuisance, 146 

Ears, conservation of hearing, 

262 
Eyes, conservation of vision, 

255 
Exercise and recreation for 

busy man or woman, 128 

First aid to the injured, 265 
the drowning, 99 
heat victims, 97 

(269) 



270 



Index 



Fly, the enemy at home, 79 
Foods, handling of, 199 
nutritive value of low priced, 
196 
Foot strain, 155 
Fourth of July, 110 
Fresh air, 132 

Garage, ventilation, 137 
Garbage disposal, 195 
Gardens, vacant lots and, 130 . 
Gas, coal, detrimental to health, 

142 
Germs, useful in industries, 90 
Grippe, don't catch, 22 

Hay fever, 59 

Health and recreation, 123 
day and its significance, 117 
hints for Christmas, 112 
of women wage earners, 121 
resolutions for the New 
Year, 115 

Hearing, conservation of, 262 

Heat victims, first aid, 97 

Heating the home, 139 

Home sanitation, 175 

Hot weather, keeping cool in, 
95 

Hydrophobia, 102 

Infantile paralysis, 49 
Infections of mouth as cause 

of general disease, 60 
Influenza, 22 

Inoculation, preventive, 182 
Insanitv, prevention of, 63 

Keeping cool in hot weather, 95 



Lots and gardens, vacant, 130 

Malicious medicine habit, 70 
Measles, a serious disease, 43 
Meat and cattle inspection, 215 
Meats, spoiled, ptomaine poi- 
soning, 106 
Medicines, misbranded, 72t 

malicious habit, 70 
Meningitis, cerebrospinal, 51 
Milk, care of in home, 204 

a perfect food, 210 

what public should know 
about, 207 
Mouth infections, 60 
Mumps, 47 

New Year resolutions, 115 
Noise, stop that, 168 
Nose, see adenoids, 260 

Occupation and disease, 151 
Open window habit, 134 

Pests, getting rid of household, 
75 

Physical training and hygiene 
for busy people, 128 

Pneumonia, coughs and colds, 
53 
facts on causes and preven- 
tion, 55 

Preventable disease, high cost 
of, 66 

Prevention of industrial acci- 
dents, 153 
insanity, 63 

Ptomaine poisoning, 106 



Index 



271 



Rag shops, regulation of, 191 
Rats, damage caused by, 80 
Recreation and health, 123 

exercise for busy man and 
woman, 128 

exercise for school children, 
124 
Refuse disposal, 195 
Registration of births, 217 
Resorts, summer, 105 
Restaurants, sanitary, 202 

Safety hints for bathers, 99 

first, 150 
Sanitation, home, 175 
Scarlet fever, 34 

household care of, 36 
School children, care of, 230 
defective vision among, 253 
diet for, 234 
exercise and recreation for, 

124 
preparing, 227 
trivial complaints among, 
251 
Sewage disposal, 193 
Sleep, essential to good health, 

163 
Smallpox, how to avoid, 41 
Soil, diseases assoicated with, 

93 
Sore throat, 24 
Spit, why you should not, 57 
Spring tonics, 68 
Streets, clean, 143 
safety on, 148 
first, 150 



Summer resorts, 104 
Swimming pools, sanitary, 173 

Teeth essential to good health, 

258 
Throat, sore, 24 
Tonics, spring, 68 
Tonsils and adenoids, 260 
Towel, common, 180 
Tuberculosis, 5 

facts about, 10 

fresh air treatment of, 7 
Typhoid fever, 1 

carriers, 2 

Undeweight and its signifi- 
cance, 157 

Vacant lots and gardens, 130 
Ventilate the garage, 137 
Ventilation, open window habit, 
134 
heating and, 139 
Vermin, see household pests, 

75 
Vision, conservation of, 255 
blindness among babies, 219 

Water, pure, 212 

Wash rag, 180 

Weather, hot, keeping cool in, 

95 
Whooping cough, 45 
Women wap-e earners, health 

of, 121 
Why you should not spit, 57 



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